MEDICARE: KEVIN IRVING STROH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E34670	CA
2	213E00000X	Podiatrist	E3467	CA
3	213ER0200X	Radiology Podiatrist	E3467	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104829431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN IRVING STROH DPM

Provider Business Mailing Address
First Line	:	1300 W LODI AVE
Second Line	:	STE W
City	:	LODI
State	:	CA
Zip	:	95242-3037
Country	:	US
Telephone Number	:	209-334-6664
Fax Number	:	209-334-2379

Provider Business Practice Location Address
First Line	:	1300 W LODI AVE
Second Line	:	STE W
City	:	LODI
State	:	CA
Zip	:	95242-3037
Country	:	US
Telephone Number	:	209-334-6664
Fax Number	:	209-334-2379

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/19/2010

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