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1881858694

NPI Code Detail

MEDICARE: MR. TIMOTHY LEE TRAUGOTT ACNP

MEDICARE: MR. TIMOTHY LEE TRAUGOTT ACNP

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	363LA2100X	Acute Care Nurse Practitioner	0024177398	VA
2	363L00000X	Nurse Practitioner	L154631	IA
3	363L00000X	Nurse Practitioner	AP116679	TX
4	363L00000X	Nurse Practitioner	9826	WI
5	363L00000X	Nurse Practitioner	4704351488	MI
6	363LA2100X	Acute Care Nurse Practitioner	4704351488	MI
7	164W00000X	Licensed Practical Nurse	683774	TX
8	363L00000X	Nurse Practitioner	AP11174	AZ
9	363LA2100X	Acute Care Nurse Practitioner	683774	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01254148	OTHER	TX	MEDICARE RR
6	P00982598	OTHER	TX	MEDICARE RR
9	P01094717	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1881858694	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	845N38	OTHER	TX	BLUE CROSS BLUE SHIELD
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881858694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY LEE TRAUGOTT ACNP

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	313-874-4806
Fax Number	:	313-876-1305

Provider Business Practice Location Address
First Line	:	15855 19 MILE RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-3504
Country	:	US
Telephone Number	:	586-263-2300
Fax Number	:	313-876-1305

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

Provider Enumeration Date	:	07/11/2008
Last Update Date	:	12/05/2025

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Directions to “ MR. TIMOTHY LEE TRAUGOTT ACNP” Practice Location

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