Provider Demographics
NPI:1467473462
Name:TRUM, PAULETTE C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:C
Last Name:TRUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HAMMES AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8139
Mailing Address - Country:US
Mailing Address - Phone:815-729-7790
Mailing Address - Fax:815-725-8144
Practice Address - Street 1:210 N HAMMES AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8139
Practice Address - Country:US
Practice Address - Phone:815-729-7790
Practice Address - Fax:815-725-8144
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360726982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760647226OtherNPI
IL211727Medicare PIN
IL260050585Medicare PIN
1760647226OtherNPI
IL140213Medicare PIN
ILIL1041Medicare PIN