Provider Demographics
NPI:1407174527
Name:TRACH, ELLIOT IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:IRWIN
Last Name:TRACH
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 1:6466 HUMMINGBIRD LANE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55346-1829
Mailing Address - Country:US
Mailing Address - Phone:952-974-0607
Mailing Address - Fax:
Practice Address - Street 1:6466 HUMMINGBIRD LANE
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-1829
Practice Address - Country:US
Practice Address - Phone:952-974-0607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN#23190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics