Provider Demographics
NPI:1164669206
Name:MICHAEL A. TRAUB, M.D., APMC
Entity Type:Organization
Organization Name:MICHAEL A. TRAUB, M.D., APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:TRAUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1337-436-6100
Mailing Address - Street 1:711 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5785
Mailing Address - Country:US
Mailing Address - Phone:337-436-6100
Mailing Address - Fax:337-439-4484
Practice Address - Street 1:711 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5785
Practice Address - Country:US
Practice Address - Phone:337-436-6100
Practice Address - Fax:337-439-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014217261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1177253Medicaid
LA55634Medicare PIN
LAB65800Medicare UPIN