Provider Demographics
NPI:1164513123
Name:TRADER, JOSEPH EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDGAR
Last Name:TRADER
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:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-0907
Mailing Address - Country:US
Mailing Address - Phone:920-682-6376
Mailing Address - Fax:920-682-6778
Practice Address - Street 1:501 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-4039
Practice Address - Country:US
Practice Address - Phone:920-682-6376
Practice Address - Fax:920-682-6778
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18035207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30171800Medicaid
WI200010934OtherRAILROAD MEDICARE
WI30171800Medicaid
WI200010934OtherRAILROAD MEDICARE