Healthcare Provider Details

I. General information

NPI: 1447239678
Provider Name (Legal Business Name): JOHN S STRATTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 PARK FOREST DR SUITE 210
TRAVERSE CITY MI
49684-7331
US

IV. Provider business mailing address

4100 PARK FOREST DR SUITE 210
TRAVERSE CITY MI
49684-7331
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5770
  • Fax: 231-935-0747
Mailing address:
  • Phone: 231-935-5770
  • Fax: 231-935-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5101013388
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberJS013388
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: