Provider Demographics
NPI:1679517825
Name:KRAUSE, THERESA D (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:D
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 HWY 6 SOUTH
Mailing Address - Street 2:STE 100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845
Mailing Address - Country:US
Mailing Address - Phone:979-690-4480
Mailing Address - Fax:979-690-4481
Practice Address - Street 1:4401 HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4428
Practice Address - Country:US
Practice Address - Phone:979-690-4480
Practice Address - Fax:979-690-4481
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6236207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121087OtherSUPERIOR
TX164422102Medicaid
TX8P8110OtherBLUE CROSS BLUE SHIELD
TX160107204Medicaid
TX160107206Medicaid
TXP00048265OtherRAILROAD MEDICARE
TX160107206Medicaid
TX160107204Medicaid