Provider Demographics
NPI:1023015435
Name:KENNETH D KRAUSE MD PC
Entity Type:Organization
Organization Name:KENNETH D KRAUSE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-750-2082
Mailing Address - Street 1:2600 S PARKER RD
Mailing Address - Street 2:#4-242
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1613
Mailing Address - Country:US
Mailing Address - Phone:303-750-2082
Mailing Address - Fax:303-750-6313
Practice Address - Street 1:2600 S PARKER RD
Practice Address - Street 2:#4-242
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1613
Practice Address - Country:US
Practice Address - Phone:303-750-2082
Practice Address - Fax:303-750-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20384208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC534978Medicare PIN