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General NPI Number Information
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NPI Number | 1184256000
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Entity Type | Individual
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Provider Name | HERBERT PARKER STRIDE
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Gender | Male
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Dates
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Enumeration Date | 02/08/2020
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Last Update Date | 02/08/2020
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 875-770-8216
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Fax |
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Provider Business Mailing Address
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Address Line | 1426 ELGIN AVE APT 3
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City | FOREST PARK
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State | IL
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Zip | 60130-2666
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Country | US
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Telephone | 847-641-1502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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