Healthcare Provider Details

I. General information

NPI: 1588638068
Provider Name (Legal Business Name): BRIAN KRAUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 EAST MAPLE STREET
CARSON CITY MI
48811
US

IV. Provider business mailing address

406 E ELM STREET PO BOX 730
CARSON CITY MI
48811
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-6472
  • Fax: 989-584-3747
Mailing address:
  • Phone: 989-584-3971
  • Fax: 989-584-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301058328
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: