Provider Demographics
NPI:1528221322
Name:STRAHLE, JENNIFER MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MAE
Last Name:STRAHLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8057
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-2810
Mailing Address - Fax:314-454-2818
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED NEUROLOGICAL SURGERY, STE 4E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-2810
Practice Address - Fax:314-454-2818
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MO2015007405207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200026626Medicaid
ILENROLLEDMedicaid