Provider Demographics
NPI:1063430544
Name:KRAUSE, MARK DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1439 N MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1113
Mailing Address - Country:US
Mailing Address - Phone:312-654-8174
Mailing Address - Fax:312-654-8103
Practice Address - Street 1:500 E 51ST ST
Practice Address - Street 2:SUITE 7047
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-2678
Practice Address - Fax:312-572-2780
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology