Provider Demographics
NPI:1881815603
Name:TRAZKOVICH, MICHELE K (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:K
Last Name:TRAZKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLEY
Other - Middle Name:K
Other - Last Name:TRAZKOVICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17 SUNDAY CT.
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6111
Mailing Address - Country:US
Mailing Address - Phone:410-526-2809
Mailing Address - Fax:410-526-2809
Practice Address - Street 1:17 SUNDAY CT.
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-6111
Practice Address - Country:US
Practice Address - Phone:410-526-2809
Practice Address - Fax:410-526-2809
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00354002084H0002X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9212 MKOtherBLUE CROSS BLUE SHIELD
MDF18650Medicare UPIN