Provider Demographics
NPI:1164693362
Name:JOHN H. TRASK, PH.D. PLLC
Entity Type:Organization
Organization Name:JOHN H. TRASK, PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:TRASK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-689-4600
Mailing Address - Street 1:650 E BIG BEAVER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1432
Mailing Address - Country:US
Mailing Address - Phone:248-689-4600
Mailing Address - Fax:248-689-4600
Practice Address - Street 1:650 E BIG BEAVER RD
Practice Address - Street 2:SUITE A
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1432
Practice Address - Country:US
Practice Address - Phone:248-689-4600
Practice Address - Fax:248-689-4600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007751251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS0895Medicare UPIN
MIP23770001Medicare PIN