Provider Demographics
NPI:1669447611
Name:STRAUSS, JODIE L (DO)
Entity Type:Individual
Prefix:DR
First Name:JODIE
Middle Name:L
Last Name:STRAUSS
Suffix:
Gender:F
Credentials:DO
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 772040
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2040
Mailing Address - Country:US
Mailing Address - Phone:800-589-6006
Mailing Address - Fax:
Practice Address - Street 1:1611 S GREEN RD STE 260
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4192
Practice Address - Country:US
Practice Address - Phone:216-381-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010689L174400000X
OH34.010979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001896645 0003Medicaid
PA001896645 0003Medicaid
PA057272PD9Medicare ID - Type Unspecified