Provider Demographics
NPI:1750315727
Name:STEPHEN M. KRAUSE M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STEPHEN M. KRAUSE M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-897-1733
Mailing Address - Street 1:1025 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2413
Mailing Address - Country:US
Mailing Address - Phone:415-897-1733
Mailing Address - Fax:
Practice Address - Street 1:1025 5TH ST
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-2413
Practice Address - Country:US
Practice Address - Phone:415-897-1733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4710817Medicaid
CAA89181Medicare UPIN