Provider Demographics
NPI:1356325740
Name:TRAKTMAN, MICHAEL E (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:TRAKTMAN
Suffix:
Gender:M
Credentials:DO
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 549
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0549
Mailing Address - Country:US
Mailing Address - Phone:906-776-5665
Mailing Address - Fax:
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014843207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4622125Medicaid
MI114957486Medicaid
MI1356325740Medicaid
MI5101014843OtherMICHIGAN LICENSE NUMBER
MI0M36120013Medicare ID - Type Unspecified
MI4622125Medicaid
MIP29950020Medicare PIN
P00359089Medicare PIN
MI114957486Medicaid
MIP34920007Medicare PIN