Provider Demographics
NPI:1164412045
Name:TRAISMAN BENUCK TRAISMAN & MERENS
Entity Type:Organization
Organization Name:TRAISMAN BENUCK TRAISMAN & MERENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:TRAISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-869-4300
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-0640
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:1325 HOWARD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3766
Practice Address - Country:US
Practice Address - Phone:847-869-4300
Practice Address - Fax:847-869-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN