Provider Demographics
NPI:1225005275
Name:KRAUSE, MARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LAKESIDE DR STE 209
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1271
Mailing Address - Country:US
Mailing Address - Phone:847-562-1410
Mailing Address - Fax:847-562-0830
Practice Address - Street 1:4905 OLD ORCHARD CTR STE 200
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1462
Practice Address - Country:US
Practice Address - Phone:847-673-3130
Practice Address - Fax:847-673-3183
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072664207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29185Medicare PIN
ILK29180Medicare PIN
ILE24399Medicare UPIN