Provider Demographics
NPI:1639168628
Name:PAULUS, KRISTEN L (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:L
Last Name:PAULUS
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:5880 RAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5118
Practice Address - Country:US
Practice Address - Phone:941-917-2300
Practice Address - Fax:941-923-1453
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73853208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253249200Medicaid
FL42492OtherBCBS
FL42492ZMedicare PIN
FLG60985Medicare UPIN
FL42492YMedicare PIN