Provider Demographics
NPI:1619930427
Name:TRAURIG, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:TRAURIG
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 1:102 WINTER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5179
Mailing Address - Country:US
Mailing Address - Phone:864-297-8059
Mailing Address - Fax:
Practice Address - Street 1:540 OLD HOWELL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1969
Practice Address - Country:US
Practice Address - Phone:864-235-9008
Practice Address - Fax:864-235-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3063Medicaid
SCF65566Medicare UPIN
SCGP3063Medicaid