Healthcare Provider Details

I. General information

NPI: 1922095769
Provider Name (Legal Business Name): MICHAEL D KRAUSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S CREASY LN SUITE 120
LAFAYETTE IN
47905-7438
US

IV. Provider business mailing address

PO BOX 4699
LAFAYETTE IN
47903-4699
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-4165
  • Fax: 765-447-5939
Mailing address:
  • Phone: 765-449-2732
  • Fax: 765-449-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01037755A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number01037755A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: