Provider Demographics
NPI:1558312207
Name:STRAWN, ESTIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTIL
Middle Name:
Last Name:STRAWN
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 1:6815 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8420
Mailing Address - Country:US
Mailing Address - Phone:262-857-5600
Mailing Address - Fax:262-857-1171
Practice Address - Street 1:6815 118TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8420
Practice Address - Country:US
Practice Address - Phone:262-857-5600
Practice Address - Fax:262-857-1171
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24043207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000198DOtherHUMANA
WI1558312207Medicaid
B56930Medicare UPIN
WI042F73601Medicare PIN
WI1558312207Medicaid
WI680862628Medicare PIN