Healthcare Provider Details

I. General information

NPI: 1164712873
Provider Name (Legal Business Name): JOHN JOSEPH VAN STRATEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 VALLEY VIEW DR
MOLINE IL
61265-6152
US

IV. Provider business mailing address

520 VALLEY VIEW DR
MOLINE IL
61265-6152
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-3621
  • Fax:
Mailing address:
  • Phone: 309-762-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036143982
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036143982
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036143982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: