MEDICARE: MR. JACOB DYLAN KRAUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1013702182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB DYLAN KRAUS

Provider Business Mailing Address
First Line	:	8779 CHINABERRY CIR N
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-2328
Country	:	US
Telephone Number	:	440-666-7530
Fax Number	:

Provider Business Practice Location Address
First Line	:	6092 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3225
Country	:	US
Telephone Number	:	440-462-4677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	11/25/2025

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