Provider Demographics
NPI:1619907656
Name:TRAUTWEIN, JANE F (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:F
Last Name:TRAUTWEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:F
Other - Last Name:WICZKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3893 TATTON PARK
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5714
Mailing Address - Country:US
Mailing Address - Phone:606-776-2679
Mailing Address - Fax:
Practice Address - Street 1:1101 VETERANS DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-2235
Practice Address - Country:US
Practice Address - Phone:859-233-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24234207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64242340Medicaid
KYC76380Medicare UPIN