Provider Demographics
NPI:1346233467
Name:TRASK, DOUGLAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:K
Last Name:TRASK
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 1:2200 W 3RD ST STE 120B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-5902
Mailing Address - Country:US
Mailing Address - Phone:213-484-7310
Mailing Address - Fax:213-484-7320
Practice Address - Street 1:2200 W 3RD ST STE 120B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-484-7310
Practice Address - Fax:213-484-7320
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33726207Y00000X
MI4301063970207Y00000X
CAC153807207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5286199Medicaid
IA22856OtherWELLMARK BCBS
IA0216960Medicaid
H23530Medicare UPIN
MIH23530Medicare UPIN
MI5286199Medicaid
IA080161512Medicare PIN