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General NPI Number Information
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NPI Number | 1891006276
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Entity Type | Individual
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Provider Name | MARTA M VANSTRATEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 403 E. 1ST STREET KATHERINE SHAW BETHEA HOSPITAL
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City | DIXON
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State | IL
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Zip | 61021
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Country | US
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Telephone | 815-285-5580
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Fax | 815-285-5584
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Provider Business Mailing Address
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Address Line | 403 E. 1ST STREET KATHERINE SHAW BETHEA HOSPITAL
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City | DIXON
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State | IL
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Zip | 61021
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Country | US
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Telephone | 815-285-5580
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Fax | 815-285-5584
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | BP1006276
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5101018708
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 036.143928
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License Number State | IL
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