Provider Demographics
NPI:1124010509
Name:KRAUSE, ALBERT HENRY (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:HENRY
Last Name:KRAUSE
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 1:975 SE SANDY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1308
Mailing Address - Country:US
Mailing Address - Phone:503-963-2846
Mailing Address - Fax:503-963-9505
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE 315
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-226-6321
Practice Address - Fax:503-227-3422
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08494208G00000X
WAMD00020667208G00000X
MOR3034208G00000X
CAG15870208G00000X
MT6808208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8291601Medicaid
OR233791Medicaid
WAAB37112Medicare ID - Type UnspecifiedVANCOUVER
WA8291601Medicaid
OR115795Medicare ID - Type UnspecifiedPORTLAND