Provider Demographics
NPI:1942647425
Name:KRAEMER, CODYJO KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:CODYJO
Middle Name:KENNETH
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 1:5301 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2874
Mailing Address - Country:US
Mailing Address - Phone:520-324-5461
Mailing Address - Fax:520-324-2051
Practice Address - Street 1:5301 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2805
Practice Address - Country:US
Practice Address - Phone:520-324-5461
Practice Address - Fax:520-324-2051
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR73900208600000X
AZ592312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery