Provider Demographics
NPI:1609839281
Name:KRAETSCH, ROBERT ELROY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELROY
Last Name:KRAETSCH
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 1:500 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3421
Mailing Address - Country:US
Mailing Address - Phone:636-327-1202
Mailing Address - Fax:363-327-1222
Practice Address - Street 1:400 MEDICAL PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1490
Practice Address - Country:US
Practice Address - Phone:636-639-8600
Practice Address - Fax:636-639-8666
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6140207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202536827Medicaid
3603013OtherUHC
110189320OtherRR MEDICARE
58811OtherGHP
MO121347OtherBCBS
134622OtherHEALTHLINK
4000561OtherAETNA
MO202536827Medicaid
MO121347OtherBCBS