Healthcare Provider Details

I. General information

NPI: 1699012229
Provider Name (Legal Business Name): LYNNE STRACHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28800 RYAN RD STE 320
WARREN MI
48092-4269
US

IV. Provider business mailing address

29900 RAVENSCROFT
FARMINGTON HILLS MI
48331
US

V. Phone/Fax

Practice location:
  • Phone: 586-620-8100
  • Fax:
Mailing address:
  • Phone: 248-661-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601002399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: