MEDICARE: CHARLES E KRAUSE MD

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	207Q00000X	Family Medicine Physician	MD00020631	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G8859734	OTHER		MEDICARE GROUP NUMBER
2	8859735	OTHER		MEDICARE INDIVIDUAL NUMBE

General Provider Information

NPI Number	:	1225217888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES E KRAUSE MD

Provider Business Mailing Address
First Line	:	750 SWIFT BLVD
Second Line	:	SUITE 22
City	:	RICHLAND
State	:	WA
Zip	:	99352-3521
Country	:	US
Telephone Number	:	509-946-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 SWIFT BLVD
Second Line	:	SUITE 22
City	:	RICHLAND
State	:	WA
Zip	:	99352-3521
Country	:	US
Telephone Number	:	509-946-2340
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	JOANNE KRAUSE
Credential	:
Telephone Number	:	509-946-2340

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	04/18/2011

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Directions to “CHARLES E KRAUSE MD ” Practice Location

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