Provider Demographics
NPI:1447445317
Name:LESLIE STROUSE, M.D., PSC
Entity type:Organization
Organization Name:LESLIE STROUSE, M.D., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-944-2275
Mailing Address - Street 1:2625 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2536
Mailing Address - Country:US
Mailing Address - Phone:812-944-2275
Mailing Address - Fax:
Practice Address - Street 1:2625 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2536
Practice Address - Country:US
Practice Address - Phone:812-944-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN001035535261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC69390Medicare UPIN