Provider Demographics
NPI:1134116221
Name:TRAIKOFF, THOMAS J (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:TRAIKOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9471 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8702
Mailing Address - Country:US
Mailing Address - Phone:330-729-2388
Mailing Address - Fax:330-629-6468
Practice Address - Street 1:9471 MARKET ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH LIMA
Practice Address - State:OH
Practice Address - Zip Code:44452-8702
Practice Address - Country:US
Practice Address - Phone:330-726-7100
Practice Address - Fax:330-758-0347
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34005040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0922596Medicaid
OH0922596Medicaid
E76086Medicare UPIN