MEDICARE: DR. STEVEN SAMUEL TRAIKOVICH D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	3330	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	861012817	OTHER	AZ	TAX ID
2	AZ0884120	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1669576948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN SAMUEL TRAIKOVICH D.O

Provider Business Mailing Address
First Line	:	9967 E DESERT BEAUTY DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-2579
Country	:	US
Telephone Number	:	602-317-9347
Fax Number	:

Provider Business Practice Location Address
First Line	:	19636 N 27TH AVE STE 206
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4015
Country	:	US
Telephone Number	:	623-516-0930
Fax Number	:	623-580-9084

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	08/21/2019

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