Healthcare Provider Details

I. General information

NPI: 1538123419
Provider Name (Legal Business Name): KEVIN GILBERT KRAUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 MAYFAIR AVE
HIBBING MN
55746-2923
US

IV. Provider business mailing address

3605 MAYFAIR AVE
HIBBING MN
55746-2923
US

V. Phone/Fax

Practice location:
  • Phone: 218-262-3441
  • Fax:
Mailing address:
  • Phone: 218-262-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34876
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: