1356667554 NPI number — DR. TERRY SIRIPHATNABOON KRAUSE M.D.

Table of content: DR. TERRY SIRIPHATNABOON KRAUSE M.D. (NPI 1356667554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356667554 NPI number — DR. TERRY SIRIPHATNABOON KRAUSE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAUSE
Provider First Name:
TERRY
Provider Middle Name:
SIRIPHATNABOON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIRIPHATNABOON
Provider Other First Name:
TERRY
Provider Other Middle Name:
TIPANAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356667554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9135 RIDGELINE BLVD
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
HIGHLANDS RANCH
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80129-2391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-649-3140
Provider Business Mailing Address Fax Number:
303-649-3154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9475 S UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLANDS RANCH
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80126-7802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-470-4071
Provider Business Practice Location Address Fax Number:
303-470-4072
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  52381 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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