Provider Demographics
NPI:1457644304
Name:KRAUSE, GRETA LOGAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GRETA
Middle Name:LOGAN
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1729 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-1812
Mailing Address - Country:US
Mailing Address - Phone:317-742-5255
Mailing Address - Fax:844-711-3169
Practice Address - Street 1:1729 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-1812
Practice Address - Country:US
Practice Address - Phone:317-742-5255
Practice Address - Fax:844-711-3169
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004188A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry