MEDICARE: STROBEL GERIATRIC SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1003340670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STROBEL GERIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	1300 18TH ST SW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 18TH ST SW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-1326
Country	:	US
Telephone Number	:	801-860-1650
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID STROBEL
Credential	:	MD
Telephone Number	:	801-860-1650

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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