Healthcare Provider Details

I. General information

NPI: 1528553708
Provider Name (Legal Business Name): DANIELLE LYNN STRAWN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 VALPARAISO DR
MUNSTER IN
46321-4040
US

IV. Provider business mailing address

205 N EAST AVE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-9852
  • Fax: 219-836-7593
Mailing address:
  • Phone: 517-205-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number02007296A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: