Basic Information
| Provider Information | |||||||||
| NPI: | 1780777953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STRAUSBAUGH | ||||||||
| FirstName: | C | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA | ||||||||
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| OtherLastName: | STRAUSBAUGH | ||||||||
| OtherFirstName: | C | ||||||||
| OtherMiddleName: | JAY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 58 | ||||||||
| Address2: | |||||||||
| City: | CADILLAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496010058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668987139 | ||||||||
| FaxNumber: | 6169759824 | ||||||||
| Practice Location | |||||||||
| Address1: | 9249 W LAKE CITY RD | ||||||||
| Address2: | |||||||||
| City: | HOUGHTON LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486299602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894225122 | ||||||||
| FaxNumber: | 9894224378 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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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 | 363A00000X | 5601004882 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.