Organization
K M B S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE A STRAYER MD (PRESIDENT)
(217) 464-2966
Entity
Organization
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3883
(217) 464-2966
(217) 464-3193
Mailing address
PO BOX 790129, ST LOUIS, MO 63179-0129
(217) 464-2966
(217) 464-3193
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0581522929
BCBS
IL
Enumeration date
03/29/2006
Last updated
01/07/2015
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