Provider Demographics
NPI:1942290721
Name:KRAMER, BRYAN CORTIS (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:CORTIS
Last Name:KRAMER
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 1:4105 E FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-3641
Mailing Address - Country:US
Mailing Address - Phone:303-539-0736
Mailing Address - Fax:303-539-0737
Practice Address - Street 1:4105 E FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3641
Practice Address - Country:US
Practice Address - Phone:303-539-0736
Practice Address - Fax:303-539-0737
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2194242086S0129X, 208G00000X, 208G00000X
CODR-495732086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02288306Medicaid
H68058Medicare UPIN
NYRA 0779Medicare ID - Type UnspecifiedUPSTATE
NY00N91230Medicare ID - Type UnspecifiedDOWNSTATE