Provider Demographics
NPI:1508094137
Name:KRUSE, KEVIN KARL II (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:KARL
Last Name:KRUSE
Suffix:II
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 1:8210 WALNUT HILL LN
Mailing Address - Street 2:STE 130
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-750-8112
Mailing Address - Fax:214-739-0529
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:STE 130
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-750-8112
Practice Address - Fax:214-739-0529
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31718207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery