Provider Demographics
NPI:1316063613
Name:STRATTON, THOMAS LEE (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:STRATTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-421-7497
Practice Address - Street 1:25 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1374
Practice Address - Country:US
Practice Address - Phone:812-436-0205
Practice Address - Fax:812-436-0207
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066257A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200958750Medicaid
IN000000660238OtherANTHEM BCBS
IN200079040GMedicaid
INM400051915Medicare PIN