MEDICARE: COREY JOSEPH STRAWSER

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	2255A2300X	Athletic Trainer		MI
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1356806897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY JOSEPH STRAWSER

Provider Business Mailing Address
First Line	:	1531 HILLSBORO AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-9783
Country	:	US
Telephone Number	:	616-914-5602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1531 HILLSBORO AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-9783
Country	:	US
Telephone Number	:	616-914-5602
Fax Number	:

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

Provider Enumeration Date	:	02/08/2019
Last Update Date	:	02/08/2019

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Directions to “ COREY JOSEPH STRAWSER ” Practice Location

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