Provider Demographics
NPI:1457347593
Name:STRAM, MICHELLE NETTY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NETTY
Last Name:STRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LIFE MARK DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1598
Mailing Address - Country:US
Mailing Address - Phone:215-257-1127
Mailing Address - Fax:215-257-0129
Practice Address - Street 1:3 LIFE MARK DR
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1598
Practice Address - Country:US
Practice Address - Phone:215-257-1127
Practice Address - Fax:215-257-0129
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043456E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABU895969OtherMEDICARE GROUP #
PA0012434980001Medicaid
PA410628LUBMedicare PIN
PABU895969OtherMEDICARE GROUP #