Healthcare Provider Details

I. General information

NPI: 1326400276
Provider Name (Legal Business Name): MICHAEL THOMAS STRATTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # 2008
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # 5021
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7966
  • Fax: 513-636-7967
Mailing address:
  • Phone: 513-636-5278
  • Fax: 513-636-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.136113
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: