MEDICARE: MARK KRAUTHEIM M.D.

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	207T00000X	Neurological Surgery Physician	31629	CO
2	207T00000X	Neurological Surgery Physician	G70341	CA
3	2083A0100X	Aerospace Medicine Physician	31629	CO
4	2083A0100X	Aerospace Medicine Physician	G70341	CA

General Provider Information

NPI Number	:	1225108731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK KRAUTHEIM M.D.

Provider Business Mailing Address
First Line	:	238 ALTA AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-4511
Country	:	US
Telephone Number	:	210-826-4648
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 LOUIS BAUER DR
Second Line	:	USAFSAMGE
City	:	BROOKS CITY-BASE
State	:	TX
Zip	:	78235-5130
Country	:	US
Telephone Number	:	210-536-2845
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	09/11/2025

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