MEDICARE: BRIAN PATRICK STRUYK MD

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	207LP3000X	Pediatric Anesthesiology Physician	A100130	CA
2	207LP3000X	Pediatric Anesthesiology Physician	MD435192	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	190520EJL	OTHER	PA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396721411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN PATRICK STRUYK MD

Provider Business Mailing Address
First Line	:	100 E PENN SQ
Second Line	:	THE WANAMAKER BUILDING, 9TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3323
Country	:	US
Telephone Number	:	297-425-9300
Fax Number	:	297-425-9331

Provider Business Practice Location Address
First Line	:	34TH STREET AND CIVIC CENTER BLVD,
Second Line	:	SUITE 9329
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4399
Country	:	US
Telephone Number	:	215-590-1858
Fax Number	:	215-590-1415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	04/11/2013

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Directions to “ BRIAN PATRICK STRUYK MD” Practice Location

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