Provider Demographics
NPI:1477552040
Name:STRYCKER, S DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:S DOUGLAS
Middle Name:
Last Name:STRYCKER
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 128
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IN
Mailing Address - Zip Code:46542-0128
Mailing Address - Country:US
Mailing Address - Phone:574-658-4142
Mailing Address - Fax:574-658-3160
Practice Address - Street 1:201 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IN
Practice Address - Zip Code:46542-0128
Practice Address - Country:US
Practice Address - Phone:574-658-4142
Practice Address - Fax:574-658-3160
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031194A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12935OtherPHP IND #
IN100144840AMedicaid
IN200300890AMedicaid
IN000000112486OtherANTHEM BCBS IND #
IN200300890AMedicaid
IN080161258Medicare PIN
IN100144840AMedicaid