Provider Demographics
NPI:1336147735
Name:STRAKA, ERIC J (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:STRAKA
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 1:2200 GREEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-994-7446
Mailing Address - Fax:734-623-8590
Practice Address - Street 1:2200 GREEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105
Practice Address - Country:US
Practice Address - Phone:734-994-7446
Practice Address - Fax:734-623-8590
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4187089Medicaid
MI4187089Medicaid
MIH14888Medicare UPIN
MIH14888Medicare UPIN
MI0813039OtherBCBS