MEDICARE: MR. MICHAEL D STRANGE LMT

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	174400000X	Specialist	6261	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	135043	OTHER		IMA NUMBER

General Provider Information

NPI Number	:	1114079241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL D STRANGE LMT

Provider Business Mailing Address
First Line	:	1618 WARNER AVE
Second Line	:
City	:	MINERAL RIDGE
State	:	OH
Zip	:	44440-9526
Country	:	US
Telephone Number	:	330-505-9913
Fax Number	:	990-759-9914

Provider Business Practice Location Address
First Line	:	1618 WARNER AVE
Second Line	:
City	:	MINERAL RIDGE
State	:	OH
Zip	:	44440-9526
Country	:	US
Telephone Number	:	330-505-9913
Fax Number	:	990-759-9914

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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