1518134410 NPI number — ELENA CARAMAN KRAUSE MD

Table of content: ELENA CARAMAN KRAUSE MD (NPI 1518134410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518134410 NPI number — ELENA CARAMAN KRAUSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAUSE
Provider First Name:
ELENA
Provider Middle Name:
CARAMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARAMAN
Provider Other First Name:
ELENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518134410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2330 N LINCOLN PARK W
Provider Second Line Business Mailing Address:
APT 2C
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60614-6077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-590-0960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N2950 STATE ROAD 67
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE GENEVA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53147-2655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-245-0535
Provider Business Practice Location Address Fax Number:
262-245-2248
Provider Enumeration Date:
05/11/2008

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: 207P00000X , with the licence number:  036128108 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 57675-20 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036128108 5 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CARAMELE . This is a "MERCYCARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1518134410 . This is a "BCBSWI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1518134410 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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