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General NPI Number Information
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NPI Number | 1770687311
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Entity Type | Individual
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Provider Name | MICHAEL YVAN STREAHLE PAC
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Gender | Male
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 400 LIBERTY HILL RD
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City | LUMBERTON
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State | NC
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Zip | 28358-2446
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Country | US
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Telephone | 910-739-3318
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Fax |
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Provider Business Mailing Address
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Address Line | 140 PINE MEADOWS RD
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City | PINEHURST
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State | NC
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Zip | 28374-9532
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Country | US
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Telephone | 910-315-6632
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Fax | 843-507-8372
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 103002
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1437
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License Number State | SC
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