Provider Demographics
NPI:1124097332
Name:KRAUSE, PHILIP CHARLES (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:CHARLES
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:1116 N 16TH ST., SUITE A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8807
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038669A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200083830Medicaid
IN9035423OtherPHCS PID NUMBER
IN000000197896OtherANTHEM PROVIDER NUMBER
IN10825428OtherCAQH NUMBER
IN200083830Medicaid
INE92926Medicare UPIN
IN815490IMedicare PIN
IN060048211Medicare PIN
IN10825428OtherCAQH NUMBER
IN815500B8Medicare PIN
IN921480CCMedicare PIN