Organization
PREVENTIVE INTERNAL MEDICINE GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON JEROME KRAUS MD (PARTNER)
(901) 761-9097
Entity
Organization
Contact information
Practice address
6005 PARK AVE, SUITE 728B, MEMPHIS, TN 38119
(901) 761-9097
(901) 682-7635
Mailing address
6005 PARK AVE, SUITE 728B, MEMPHIS, TN 38119
(901) 761-9097
(901) 682-7635
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB4812
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
08/22/2020
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