Provider Demographics
NPI:1679800866
Name:BRAMER, ANDREW (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BRAMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3745
Mailing Address - Country:US
Mailing Address - Phone:815-762-5931
Mailing Address - Fax:
Practice Address - Street 1:3100 THEODORE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8534
Practice Address - Country:US
Practice Address - Phone:815-725-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003604363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical