Provider Demographics
NPI:1225108731
Name:KRAUTHEIM, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KRAUTHEIM
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 1:238 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4511
Mailing Address - Country:US
Mailing Address - Phone:210-826-4648
Mailing Address - Fax:
Practice Address - Street 1:2601 LOUIS BAUER DR
Practice Address - Street 2:USAFSAMGE
Practice Address - City:BROOKS CITY-BASE
Practice Address - State:TX
Practice Address - Zip Code:78235-5130
Practice Address - Country:US
Practice Address - Phone:210-536-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31629207T00000X, 2083A0100X
CAG70341207T00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine