Healthcare Provider Details

I. General information

NPI: 1568446912
Provider Name (Legal Business Name): HOWARD T STRASSNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SILVER CROSS BLVD STE 215
NEW LENOX IL
60451-9626
US

IV. Provider business mailing address

1890 SILVER CROSS BLVD STE 215
NEW LENOX IL
60451-9626
US

V. Phone/Fax

Practice location:
  • Phone: 312-997-2229
  • Fax: 773-797-2884
Mailing address:
  • Phone: 312-997-2229
  • Fax: 773-797-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number036-060657
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036060657
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: