Provider Demographics
NPI:1447314547
Name:KRAMER, BETHANY A (PA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:KRAMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:EBERLE 610
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3630
Mailing Address - Fax:847-981-3626
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:EBERLE 610
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3630
Practice Address - Fax:847-981-3626
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004620363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00156369Medicaid
WIP00156369Medicaid
WIP78669Medicare UPIN