Provider Demographics
NPI:1184477325
Name:STRAWDER, DANIEL T
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:STRAWDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1387
Mailing Address - Country:US
Mailing Address - Phone:248-525-7017
Mailing Address - Fax:
Practice Address - Street 1:13740 VERNON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1387
Practice Address - Country:US
Practice Address - Phone:248-525-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker