Healthcare Provider Details

I. General information

NPI: 1780809947
Provider Name (Legal Business Name): CHRISTIAN JOHN STRECK JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST SUITE 418 CSB MSC 613
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

96 JONATHAN LUCAS ST SUITE 418 CSB MSC 613
CHARLESTON SC
29425-8900
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3851
  • Fax:
Mailing address:
  • Phone: 843-792-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberTL 31063
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: