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NPI Code Detail

MEDICARE: MR. MICHAEL EDWARD TRAMMELL LCSW

MEDICARE:  MR. MICHAEL EDWARD TRAMMELL  LCSW
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
11041C0700XClinical Social Worker149-009767IL

General Provider Information

NPI Number : 1972527075
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL EDWARD TRAMMELL LCSW
Provider Business Mailing Address
First Line : 3166 N LINCOLN AVE
Second Line : SUITE 214
City : CHICAGO
State : IL
Zip : 60657-3119
Country : US
Telephone Number : 773-559-1069
Fax Number :
Provider Business Practice Location Address
First Line : 3166 N LINCOLN AVE
Second Line : SUITE 214
City : CHICAGO
State : IL
Zip : 60657-3119
Country : US
Telephone Number : 773-559-1069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 06/14/2012

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Directions to “ MR. MICHAEL EDWARD TRAMMELL LCSW” Practice Location

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