Provider Demographics
NPI:1710906722
Name:KERAUS, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KERAUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:KERAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:638 S BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4742
Mailing Address - Country:US
Mailing Address - Phone:563-243-5633
Mailing Address - Fax:563-243-9567
Practice Address - Street 1:638 S BLUFF BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4742
Practice Address - Country:US
Practice Address - Phone:563-243-5633
Practice Address - Fax:563-243-9567
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00628103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR98401Medicare UPIN