Provider Demographics
NPI:1003879149
Name:KROUSE, PAUL G (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:KROUSE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:G
Other - Last Name:KROUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:1201 LIGONIER ST
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-0030
Mailing Address - Country:US
Mailing Address - Phone:724-539-3650
Mailing Address - Fax:724-539-3433
Practice Address - Street 1:1201 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1921
Practice Address - Country:US
Practice Address - Phone:724-539-3650
Practice Address - Fax:724-539-3433
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003511L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001210790003Medicaid
PA5972520001Medicare NSC
PAU02253Medicare UPIN
PA619133Medicare ID - Type Unspecified