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General NPI Number Information
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NPI Number | 1982831210
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Entity Type | Individual
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Provider Name | DAVID ALLEN KRUSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2009
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 1900 CENTRACARE CIR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-5000
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Country | US
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Telephone | 320-654-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 924 CELEBRATION CIR
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City | SARTELL
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State | MN
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Zip | 56377
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Country | US
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Telephone | 319-621-3732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | R-8721
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 54831
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License Number State | MN
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