Provider Demographics
NPI:1790759801
Name:KRAUSE, JENIFER ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:ELIZABETH
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:ELIZABETH
Other - Last Name:KRAUSE-PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36115 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1216
Mailing Address - Country:US
Mailing Address - Phone:764-464-0887
Mailing Address - Fax:719-402-0254
Practice Address - Street 1:1840 WEALTHY ST SE
Practice Address - Street 2:MC 426
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2921
Practice Address - Country:US
Practice Address - Phone:616-774-5221
Practice Address - Fax:616-774-5391
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057865207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H00234Medicare UPIN