Provider Demographics
NPI:1891781944
Name:TERRELL, TRAVIS D (MD)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:D
Last Name:TERRELL
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 1:2545 CAPITAL AVE SW
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7120
Mailing Address - Country:US
Mailing Address - Phone:269-552-0223
Mailing Address - Fax:
Practice Address - Street 1:2545 CAPITAL AVE SW
Practice Address - Street 2:SUITE 207
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-552-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITT054634207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology