Provider Demographics
NPI:1093744609
Name:STRATEGOS, EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:STRATEGOS
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:PO BOX 2326
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2326
Mailing Address - Country:US
Mailing Address - Phone:661-654-0400
Mailing Address - Fax:661-664-2633
Practice Address - Street 1:9300 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3613
Practice Address - Country:US
Practice Address - Phone:661-654-0400
Practice Address - Fax:661-654-2633
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088440Medicaid
CA00A541790Medicaid
CA00A541790Medicaid
CAGR0088440Medicaid
CAG22191Medicare UPIN
CAZZZ22804ZMedicare ID - Type UnspecifiedGROUP MEDICARE #