Provider Demographics
NPI:1669576948
Name:TRAIKOVICH, STEVEN SAMUEL (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:SAMUEL
Last Name:TRAIKOVICH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9967 E DESERT BEAUTY DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-2579
Mailing Address - Country:US
Mailing Address - Phone:602-317-9347
Mailing Address - Fax:
Practice Address - Street 1:19636 N 27TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-4015
Practice Address - Country:US
Practice Address - Phone:623-516-0930
Practice Address - Fax:623-580-9084
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3330207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861012817OtherTAX ID
AZAZ0884120OtherBLUE CROSS BLUE SHIELD
AZZ71704Medicare ID - Type UnspecifiedMEDICAR GROUP NUMBER