Healthcare Provider Details

I. General information

NPI: 1861580995
Provider Name (Legal Business Name): TODD D STRAUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 W SPENCER ST
APPLETON WI
54914-9106
US

IV. Provider business mailing address

4406 W SPENCER ST
APPLETON WI
54914-9106
US

V. Phone/Fax

Practice location:
  • Phone: 920-560-6677
  • Fax:
Mailing address:
  • Phone: 920-560-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number49993-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: