Healthcare Provider Details

I. General information

NPI: 1982831210
Provider Name (Legal Business Name): DAVID ALLEN KRUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2009
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

924 CELEBRATION CIR
SARTELL MN
56377
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3610
  • Fax:
Mailing address:
  • Phone: 319-621-3732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-8721
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number54831
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: