Basic Information
| Provider Information | |||||||||
| NPI: | 1760483325 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STROSAHL | ||||||||
| FirstName: | KURT | ||||||||
| MiddleName: | FREDERICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7068 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237070068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863525 | ||||||||
| FaxNumber: | 7576860230 | ||||||||
| Practice Location | |||||||||
| Address1: | 612 KINGSBOROUGH SQ | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233205041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575479294 | ||||||||
| FaxNumber: | 7572139342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2005 | ||||||||
| LastUpdateDate: | 05/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101 232412 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 005870291 | 05 | VA | MEDICAID |