1194721217 NPI number — DR. CHRISTOPHER H STRAYHORN M.D.

Table of content: DR. CHRISTOPHER H STRAYHORN M.D. (NPI 1194721217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194721217 NPI number — DR. CHRISTOPHER H STRAYHORN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRAYHORN
Provider First Name:
CHRISTOPHER
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194721217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 LAKE ZURICH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-381-5599
Provider Business Mailing Address Fax Number:
847-381-1431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 LAKE ZURICH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010-3141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-381-5599
Provider Business Practice Location Address Fax Number:
847-381-1431
Provider Enumeration Date:
06/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301058478 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X , with the licence number: 036139505 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4407235 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 76-30013 . This is a "PHYSICIANS HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11-0111603-1 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 38-3512985 . This is a "TAX I.D." identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".