Provider Demographics
NPI:1336130533
Name:KRAUSE, KEITH (PA-C)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12101 WOODCREST EXECUTIVE DR STE 210
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5047
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:10 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1659
Practice Address - Country:US
Practice Address - Phone:314-317-0600
Practice Address - Fax:314-317-0606
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO107846363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO104170003Medicare PIN