MEDICARE: DR. WILLIAM BRADLEY KRUSE 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	207P00000X	Emergency Medicine Physician	2005012183	MO

General Provider Information

NPI Number	:	1851329908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM BRADLEY KRUSE M.D.

Provider Business Mailing Address
First Line	:	101 W 69TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64113-2503
Country	:	US
Telephone Number	:	816-842-2571
Fax Number	:

Provider Business Practice Location Address
First Line	:	UMKC SCHOOL OF MEDICINE RESIDENCY PROGRAM
Second Line	:	M1-210, 2411 HOLMES STREET
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2792
Country	:	US
Telephone Number	:	816-235-6626
Fax Number	:	816-235-6629

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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