Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-103970 | IL |
Y | 208000000X | Pediatrician | L1007442 | MI |
NPI | 1003883281 |
---|---|
Provider Name | William B Stratbucker |
First Address | Grand Rapids, MI 49503-2560 |
Second Address | Grand Rapids, MI 49503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H87101 | (02) | IL |