Provider Demographics
NPI:1649229733
Name:TRAKRU, YOGESH (MD)
Entity Type:Individual
Prefix:DR
First Name:YOGESH
Middle Name:
Last Name:TRAKRU
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 1:3675 BOCA CHICA STE E
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-542-2273
Mailing Address - Fax:956-542-3730
Practice Address - Street 1:3675 BOCA CHICA STE E
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-542-2273
Practice Address - Fax:956-542-3730
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133437704Medicaid