Healthcare Provider Details

I. General information

NPI: 1063499101
Provider Name (Legal Business Name): TERRY STRAWSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11475 N 2ND ST
MACHESNEY PARK IL
61115-1285
US

IV. Provider business mailing address

11475 N 2ND ST
MACHESNEY PARK IL
61115-1285
US

V. Phone/Fax

Practice location:
  • Phone: 815-654-8000
  • Fax: 815-654-8020
Mailing address:
  • Phone: 815-654-8000
  • Fax: 815-654-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36053363
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: