Provider Demographics
NPI:1609051937
Name:KRAUSE, MITCHELL (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-1649
Mailing Address - Country:US
Mailing Address - Phone:610-667-1578
Mailing Address - Fax:610-808-4700
Practice Address - Street 1:917 HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-1649
Practice Address - Country:US
Practice Address - Phone:610-667-1578
Practice Address - Fax:610-808-4700
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003783-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine