Healthcare Provider Details

I. General information

NPI: 1376569483
Provider Name (Legal Business Name): DONALD W KRAUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BROADWAY
BANGOR ME
04401-1900
US

IV. Provider business mailing address

900 BROADWAY
BANGOR ME
04401-1900
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-1187
  • Fax: 207-907-1189
Mailing address:
  • Phone: 207-907-1187
  • Fax: 207-907-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD6928
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: