Provider Demographics
NPI:1063499101
Name:STRAWSER, TERRY (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:STRAWSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11475 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1285
Mailing Address - Country:US
Mailing Address - Phone:815-654-8000
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:11475 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1285
Practice Address - Country:US
Practice Address - Phone:815-654-8000
Practice Address - Fax:815-654-8020
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36053363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37296Medicare UPIN
IL769380 - L66144Medicare PIN