Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | RT011776 | MI |
NPI | 1023059037 |
---|---|
Provider Name | Richard W Traicoff |
First Address | Cincinnati, OH 45263 |
Second Address | Farmington Hills, MI 48336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 28/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114570790 | (05) | MI |
F78558 | (02) |