Provider Demographics
NPI:1851381057
Name:KROUS, TIMOTHY F (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:KROUS
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 1:2109 N KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-3908
Mailing Address - Country:US
Mailing Address - Phone:405-513-8880
Mailing Address - Fax:405-285-5912
Practice Address - Street 1:2109 N KELLY AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3908
Practice Address - Country:US
Practice Address - Phone:405-513-8880
Practice Address - Fax:405-285-5912
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21244208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H68468Medicare UPIN