Provider Demographics
NPI:1285621391
Name:CRAUN, MICHAEL LEN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEN
Last Name:CRAUN
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 1:2300 ROUND ROCK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4006
Mailing Address - Country:US
Mailing Address - Phone:512-341-6612
Mailing Address - Fax:512-341-6613
Practice Address - Street 1:2300 ROUND ROCK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4006
Practice Address - Country:US
Practice Address - Phone:512-341-6612
Practice Address - Fax:512-341-6613
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE09880Medicare UPIN