Provider Demographics
NPI:1548223860
Name:KRAUS, FREDERICK CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CHARLES
Last Name:KRAUS
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 1:250 NORTHWEST BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2974
Mailing Address - Country:US
Mailing Address - Phone:208-292-2263
Mailing Address - Fax:208-292-3130
Practice Address - Street 1:250 NORTHWEST BLVD
Practice Address - Street 2:SUITE #202
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2974
Practice Address - Country:US
Practice Address - Phone:208-292-2263
Practice Address - Fax:208-292-3130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM91172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG40080Medicare UPIN