Provider Demographics
NPI:1720092406
Name:ALLEN G. TRAGER, D.O., P.C.
Entity Type:Organization
Organization Name:ALLEN G. TRAGER, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-733-3408
Mailing Address - Street 1:PO BOX 321218
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-0021
Mailing Address - Country:US
Mailing Address - Phone:810-733-3408
Mailing Address - Fax:810-733-0984
Practice Address - Street 1:1335 S LINDEN RD
Practice Address - Street 2:SUITE C
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3420
Practice Address - Country:US
Practice Address - Phone:810-733-3408
Practice Address - Fax:810-733-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B511160OtherBLUE CROSS & BLUE SHIELD
MI0B511160OtherBLUE CROSS & BLUE SHIELD