Provider Demographics
NPI:1184715559
Name:KRAUSE, CAROL LEA (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEA
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2213
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2213
Mailing Address - Country:US
Mailing Address - Phone:701-255-2453
Mailing Address - Fax:701-255-2339
Practice Address - Street 1:705 E MAIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4525
Practice Address - Country:US
Practice Address - Phone:701-255-2453
Practice Address - Fax:701-255-2339
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6604208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDF63944Medicare UPIN