Provider Demographics
NPI:1114049202
Name:JOAN A. TRAVER,MD
Entity Type:Organization
Organization Name:JOAN A. TRAVER,MD
Other - Org Name:PARTNERS IN HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-854-4154
Mailing Address - Street 1:10539 APPLEWOOD RD
Mailing Address - Street 2:PO BOX 167
Mailing Address - City:SISTER BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54234-9004
Mailing Address - Country:US
Mailing Address - Phone:920-854-4154
Mailing Address - Fax:920-854-6826
Practice Address - Street 1:10539 APPLEWOOD RD
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9004
Practice Address - Country:US
Practice Address - Phone:920-854-4154
Practice Address - Fax:920-854-6826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB57197Medicare UPIN