Basic Information
| Provider Information | |||||||||
| NPI: | 1104384577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRAITON | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3533 SOUTHERN BLVD STE 5650 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454291263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372943611 | ||||||||
| FaxNumber: | 9372949010 | ||||||||
| Practice Location | |||||||||
| Address1: | 3533 SOUTHERN BLVD STE 5650 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454291263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372943611 | ||||||||
| FaxNumber: | 9372949010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2019 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50.005877RX | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 50.005877RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 0343256 | 05 | OH | MEDICAID |