Healthcare Provider Details

I. General information

NPI: 1003835877
Provider Name (Legal Business Name): SUSAN K STROTHEIDE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W STATE ST STE 3A
BELDING MI
48809-9245
US

IV. Provider business mailing address

1320 W STATE ST STE 3A
BELDING MI
48809-2272
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-1810
  • Fax: 616-794-1947
Mailing address:
  • Phone: 616-794-1810
  • Fax: 616-794-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: