Provider Demographics
NPI:1962609537
Name:KRAMER, MITZI MONTGOMERY (MD)
Entity type:Individual
Prefix:DR
First Name:MITZI
Middle Name:MONTGOMERY
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MITZI
Other - Middle Name:MONTGOMERY
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:34700 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4500
Mailing Address - Country:US
Mailing Address - Phone:262-303-2131
Mailing Address - Fax:262-567-3490
Practice Address - Street 1:34700 VALLEY RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4500
Practice Address - Country:US
Practice Address - Phone:262-303-2131
Practice Address - Fax:262-567-3490
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0024002084F0202X
WI64665202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry