Provider Demographics
NPI:1134290349
Name:KRAUSE, KENNETH DAVID (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:DAVID
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 1:2600 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO203842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC535018Medicare PIN