Basic Information
| Provider Information | |||||||||
| NPI: | 1588667075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAUS | ||||||||
| FirstName: | IRA | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CIRCLE 75 PKWY SE | ||||||||
| Address2: | STE. 900 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784262171 | ||||||||
| FaxNumber: | 4044461957 | ||||||||
| Practice Location | |||||||||
| Address1: | 2368 BATTLEFIELD PKWY | ||||||||
| Address2: | |||||||||
| City: | FORT OGLETHORPE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307424030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068616200 | ||||||||
| FaxNumber: | 7068616222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 02/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | DPM0000000401 | TN | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213E00000X | POD000658 | GA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 561231235E | 05 | GA | MEDICAID | 561231235G | 05 | GA | MEDICAID | 561231235B | 05 | GA | MEDICAID | 561231235C | 05 | GA | MEDICAID | 561231235D | 05 | GA | MEDICAID | 561231235I | 05 | GA | MEDICAID | 561231235J | 05 | GA | MEDICAID | 3351839 | 05 | TN | MEDICAID | 561231235A | 05 | GA | MEDICAID | 561231235F | 05 | GA | MEDICAID | 561231235H | 05 | GA | MEDICAID |