Healthcare Provider Details

I. General information

NPI: 1649346610
Provider Name (Legal Business Name): MICHAEL J STRAHAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W 5TH ST SUITE 103
SHERIDAN WY
82801-2751
US

IV. Provider business mailing address

1333 W 5TH ST SUITE 103
SHERIDAN WY
82801-2751
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-8921
  • Fax: 307-672-3944
Mailing address:
  • Phone: 307-672-8921
  • Fax: 307-672-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number3400A
License Number StateWY

VIII. Authorized Official

Name: MICHAEL J STRAHAN
Title or Position: OWNER
Credential: MD
Phone: 307-672-8921