MEDICARE: DR. JOHN STEVEN STRACKS 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	207Q00000X	Family Medicine Physician	4301085634	MI
2	207Q00000X	Family Medicine Physician	036123810	IL

General Provider Information

NPI Number	:	1790804136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN STEVEN STRACKS MD

Provider Business Mailing Address
First Line	:	1828 W WEBSTER AVE STE 450
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2916
Country	:	US
Telephone Number	:	312-489-8890
Fax Number	:	773-337-7316

Provider Business Practice Location Address
First Line	:	1828 W WEBSTER AVE STE 450
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2916
Country	:	US
Telephone Number	:	312-489-8890
Fax Number	:	773-337-7316

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/24/2020

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