Provider Demographics
NPI:1730601907
Name:KRAEMER, JACOB (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KRAEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W BELTLINE HWY STE 601
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2309
Mailing Address - Country:US
Mailing Address - Phone:608-234-7436
Mailing Address - Fax:
Practice Address - Street 1:2501 W BELTLINE HWY STE 601
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2309
Practice Address - Country:US
Practice Address - Phone:608-234-7436
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112189207L00000X
WI75282-20207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1730601907Medicaid