Provider Demographics
NPI:1588664676
Name:KRAUSE, IRA (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:
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 1:8811 FM 1960 BYPASS RD W
Mailing Address - Street 2:SUITE #300
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4023
Mailing Address - Country:US
Mailing Address - Phone:281-548-7713
Mailing Address - Fax:281-548-1414
Practice Address - Street 1:8811 FM 1960 BYPASS RD W
Practice Address - Street 2:SUITE #300
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4023
Practice Address - Country:US
Practice Address - Phone:281-548-7713
Practice Address - Fax:281-548-1414
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-05-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
TXH8184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031CXOtherBCBSTX
TX113412402Medicaid
TX2007148OtherAETNA
TX0031CXOtherBCBSTX
TX2007148OtherAETNA