Provider Demographics
NPI:1184652893
Name:KRAUS, IRVIN MARTIN (DO)
Entity Type:Individual
Prefix:
First Name:IRVIN
Middle Name:MARTIN
Last Name:KRAUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 RIVER BEND RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5255
Mailing Address - Country:US
Mailing Address - Phone:630-527-1631
Mailing Address - Fax:
Practice Address - Street 1:475 RIVER BEND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5255
Practice Address - Country:US
Practice Address - Phone:630-527-1631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3644135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2219760OtherBLUE SHIELD IL PROVIDER #