Healthcare Provider Details

I. General information

NPI: 1639849193
Provider Name (Legal Business Name): DADE ARTHUR SIDNEY STROMWALL AG-ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

IV. Provider business mailing address

30713 SCHOENHERR RD STE A
WARREN MI
48088-3122
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-2643
  • Fax: 586-265-2170
Mailing address:
  • Phone: 586-286-2643
  • Fax: 586-265-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4704402942
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1049376
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1049376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: