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Individual

JOHN STROM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
403 E 1ST ST, DIXON, IL 61021
(815) 285-5600
(815) 285-5602
Mailing address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 285-5600
(815) 285-5602

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036065016
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036065016
IL
01
091397
HEALTH ALLIANCE MEDICAL
IL
01
9815737
BLUE CROSS BLUE SHIELD
IL
01
F400378211
MEDICARE PTAN
IL
Enumeration date
10/13/2006
Last updated
08/27/2018
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