MEDICARE: DAVID LOWELL KRASNE 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G58882	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609830637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LOWELL KRASNE MD

Provider Business Mailing Address
First Line	:	11693 SAN VICENTE BLVD
Second Line	:	#147
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-5105
Country	:	US
Telephone Number	:	310-829-8101
Fax Number	:	310-829-6509

Provider Business Practice Location Address
First Line	:	1328 22ND ST
Second Line	:	PATHOLOGY DEPT
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2032
Country	:	US
Telephone Number	:	310-829-8101
Fax Number	:	310-829-6509

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	10/04/2007

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