Provider Demographics
NPI:1265849772
Name:PETER ALAN KRAUSE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PETER ALAN KRAUSE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-630-8683
Mailing Address - Street 1:2151 S COLLEGE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1302
Mailing Address - Country:US
Mailing Address - Phone:414-630-8683
Mailing Address - Fax:
Practice Address - Street 1:2151 S COLLEGE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1302
Practice Address - Country:US
Practice Address - Phone:414-630-8683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC128885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G94726Medicare UPIN
1277815Medicare PIN
WI64027899Medicaid