Provider Demographics
NPI:1922170299
Name:TRAITEL, RICHARD BERNARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BERNARD
Last Name:TRAITEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0950
Mailing Address - Country:US
Mailing Address - Phone:248-334-9000
Mailing Address - Fax:248-334-5810
Practice Address - Street 1:2550 S TELEGRAPH RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0950
Practice Address - Country:US
Practice Address - Phone:248-334-9000
Practice Address - Fax:248-334-5810
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301000798103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI620F34615OtherBC TRADITIONAL
MIS07365Medicare UPIN
MIOF34615Medicare ID - Type UnspecifiedPART B