Provider Demographics
NPI:1003119173
Name:DR.NEAL F.KROUSE, D.O.,P.A.
Entity type:Organization
Organization Name:DR.NEAL F.KROUSE, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:FARRELL
Authorized Official - Last Name:KROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-418-9445
Mailing Address - Street 1:2345 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1110
Mailing Address - Country:US
Mailing Address - Phone:954-418-9445
Mailing Address - Fax:954-418-9445
Practice Address - Street 1:2345 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1110
Practice Address - Country:US
Practice Address - Phone:954-418-9445
Practice Address - Fax:954-418-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002736700Medicaid
FL82574Medicare PIN
FLD27375Medicare UPIN