Provider Demographics
NPI:1356405559
Name:KRAUCAK, NELSON (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:KRAUCAK
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 1:1501 N US HIGHWAY 441
Mailing Address - Street 2:1704
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8999
Mailing Address - Country:US
Mailing Address - Phone:352-750-4333
Mailing Address - Fax:352-750-2032
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:1704
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-750-4333
Practice Address - Fax:352-750-2032
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378149600Medicaid
FL27437Medicare ID - Type Unspecified
FL378149600Medicaid