Provider Demographics
NPI:1639177769
Name:STRAHAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:STRAHAN
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 1:1333 W 5TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-672-8921
Mailing Address - Fax:307-672-3944
Practice Address - Street 1:1333 W 5TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-672-8921
Practice Address - Fax:307-672-3944
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-09-09
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
WY3400A207Q00000X, 207R00000X
MT9988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118602700Medicaid
WY3400AOtherWY STATE LICENSE #
MT9988OtherMONTANA STATE LICENSE NUM
WY010003564OtherRAILROAD MEDICARE PROVIDE
WY302145OtherWY BLUE SHIELD PROVIDER #
WY3400AOtherWY STATE LICENSE #
MT9988OtherMONTANA STATE LICENSE NUM