Healthcare Provider Details

I. General information

NPI: 1881840668
Provider Name (Legal Business Name): JOHN O. KRAUSE, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 SUITE 200
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

14825 N OUTER 40 SUITE 200
CHESTERFIELD MO
63017-2152
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-2555
  • Fax: 314-336-2557
Mailing address:
  • Phone: 314-336-2555
  • Fax: 314-336-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number107147
License Number StateMO

VIII. Authorized Official

Name: DR. JOHN O KRAUSE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-336-2555