MEDICARE: DR. ESTIL STRAWN 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
1	207V00000X	Obstetrics & Gynecology Physician	24043	WI
2	207VE0102X	Reproductive Endocrinology Physician	24043	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002000198D	OTHER		HUMANA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558312207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ESTIL STRAWN MD

Provider Business Mailing Address
First Line	:	6815 118TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-8420
Country	:	US
Telephone Number	:	262-857-5600
Fax Number	:	262-857-1171

Provider Business Practice Location Address
First Line	:	6815 118TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53142-8420
Country	:	US
Telephone Number	:	262-857-5600
Fax Number	:	262-857-1171

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	11/24/2021

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Directions to “ DR. ESTIL STRAWN MD” Practice Location

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