Healthcare Provider Details

I. General information

NPI: 1619918729
Provider Name (Legal Business Name): ANDREW M KRAUSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 RIDGE LAKE BLVD
MEMPHIS TN
38120-9411
US

IV. Provider business mailing address

825 RIDGE LAKE BLVD
MEMPHIS TN
38120-9411
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-2200
  • Fax: 901-820-2342
Mailing address:
  • Phone: 901-685-2200
  • Fax: 901-820-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number12981
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number21668
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number12981
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD0000021668
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberN-8386
License Number StateAR
# 6
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberN-8386
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: