Provider Demographics
NPI:1043322019
Name:CRUSE, LAURA MCILWAIN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MCILWAIN
Last Name:CRUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:MCILWAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3923
Mailing Address - Country:US
Mailing Address - Phone:813-345-2380
Mailing Address - Fax:813-971-5247
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 406
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-345-2380
Practice Address - Fax:813-971-5247
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84358207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47343OtherBLUE CROSS BLUE SHIELD
FL87146OtherBAYCARE
FL06409OtherUNIVERSAL
FLP00270226OtherRAILROAD MEDICARE
FL06409OtherUNIVERSAL
I17048Medicare UPIN