Healthcare Provider Details

I. General information

NPI: 1376504365
Provider Name (Legal Business Name): SUE A STRAYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E LAKE SHORE DRIVE ST MARYS-DECATUR
DECATUR IL
62521-3883
US

IV. Provider business mailing address

PO BOX 790129
ST LOUIS MO
63179-0129
US

V. Phone/Fax

Practice location:
  • Phone: 217-464-2966
  • Fax: 217-464-3193
Mailing address:
  • Phone: 217-964-2966
  • Fax: 217-464-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: