1588667075 NPI number — MR. IRA H KRAUS DPM

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588667075 NPI number — MR. IRA H KRAUS DPM

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KRAUS

Provider First Name:

IRA

Provider Middle Name:

H

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

DPM

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1588667075

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/15/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

900 CIRCLE 75 PKWY SE

Provider Second Line Business Mailing Address:

STE. 900

Provider Business Mailing Address City Name:

ATLANTA

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

30339-3035

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

678-426-2171

Provider Business Mailing Address Fax Number:

404-446-1957

Provider First Line Business Practice Location Address:

2368 BATTLEFIELD PKWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FORT OGLETHORPE

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

30742-4030

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

706-861-6200

Provider Business Practice Location Address Fax Number:

706-861-6222

Provider Enumeration Date:

05/27/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 213ES0103X , with the licence number:  DPM0000000401 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 213E00000X , with the licence number: POD000658 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 561231235E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 3351839 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 561231235H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".