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NPI Code Detail

MEDICARE: SUE A STRAYER MD

MEDICARE: SUE A STRAYER MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianIL

Other Identifiers

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

General Provider Information

NPI Number : 1376504365
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUE A STRAYER MD
Provider Business Mailing Address
First Line : PO BOX 790129
Second Line :
City : ST LOUIS
State : MO
Zip : 63179-0129
Country : US
Telephone Number : 217-964-2966
Fax Number : 217-464-3193
Provider Business Practice Location Address
First Line : 1800 E LAKE SHORE DRIVE
Second Line : ST MARYS-DECATUR
City : DECATUR
State : IL
Zip : 62521-3883
Country : US
Telephone Number : 217-464-2966
Fax Number : 217-464-3193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 07/08/2007

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Directions to “ SUE A STRAYER MD” Practice Location

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