Healthcare Provider Details

I. General information

NPI: 1588468169
Provider Name (Legal Business Name): PAUL STRODE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 ROUND LAKE CT
LEBANON IN
46052-9030
US

IV. Provider business mailing address

1514 ROUND LAKE CT
LEBANON IN
46052-9030
US

V. Phone/Fax

Practice location:
  • Phone: 317-441-8944
  • Fax:
Mailing address:
  • Phone: 317-441-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberF36053
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: