Provider Demographics
NPI:1013987569
Name:KRAUT, MICHELLE S (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:S
Last Name:KRAUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 FOREST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3786
Mailing Address - Country:US
Mailing Address - Phone:804-673-4200
Mailing Address - Fax:804-673-6513
Practice Address - Street 1:7110 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3786
Practice Address - Country:US
Practice Address - Phone:804-673-4200
Practice Address - Fax:804-673-6513
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN397702085R0202X, 2085N0904X
VA01012426592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
TN3334835Medicaid
TN3334835Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B
VAC06695OtherGROUP PTAN