Provider Demographics
NPI:1487647517
Name:TRAYNELIS, VINCENT C (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:C
Last Name:TRAYNELIS
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 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 970
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-6644
Mailing Address - Fax:312-942-2176
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 970
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-6644
Practice Address - Fax:312-942-2176
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27034207T00000X
IL036-122576207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0272963Medicaid
IA27296OtherWELLMARK BCBS
IA140002015Medicare PIN
IA27296OtherWELLMARK BCBS
IA27296Medicare PIN