Provider Demographics
NPI:1881689172
Name:STRACENER, WINDEL A (MD)
Entity Type:Individual
Prefix:
First Name:WINDEL
Middle Name:A
Last Name:STRACENER
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 1:203 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4208
Mailing Address - Country:US
Mailing Address - Phone:765-973-9294
Mailing Address - Fax:765-973-9233
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4208
Practice Address - Country:US
Practice Address - Phone:765-973-9294
Practice Address - Fax:765-973-9233
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0979017Medicaid
IN200112010AMedicaid
INDEC36280OtherCSHCS
INF90520Medicare UPIN
IN905920AMedicare ID - Type Unspecified
IN200112010AMedicaid
IN080101653Medicare ID - Type UnspecifiedRAILROAD MEDICARE