Healthcare Provider Details

I. General information

NPI: 1982667556
Provider Name (Legal Business Name): MATTHEW KRAUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4644 KEYSVILLE AVE
SPRING HILL FL
34608-3515
US

IV. Provider business mailing address

PO BOX 15707
CLEARWATER FL
33766-5707
US

V. Phone/Fax

Practice location:
  • Phone: 352-650-2250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME0032453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: