Provider Demographics
NPI:1578613527
Name:KRAUSE, LAWRENCE MARK (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MARK
Last Name:KRAUSE
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 1:351 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2061
Mailing Address - Country:US
Mailing Address - Phone:847-570-1700
Mailing Address - Fax:847-926-5326
Practice Address - Street 1:111 N WABASH AVE STE 1709
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2989
Practice Address - Country:US
Practice Address - Phone:847-570-1700
Practice Address - Fax:847-926-5326
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL724180Medicare ID - Type Unspecified
ILD13433Medicare UPIN
IL950190Medicare PIN