Basic Information
| Provider Information | |||||||||
| NPI: | 1932166675 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRASON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1959 SLOAN PLACE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517726235 | ||||||||
| FaxNumber: | 6517726261 | ||||||||
| Practice Location | |||||||||
| Address1: | 1959 SLOAN PLACE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517726235 | ||||||||
| FaxNumber: | 6517726261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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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 | 207R00000X | 43697 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 43697 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 767668900 | 05 | MN | MEDICAID |