Healthcare Provider Details

I. General information

NPI: 1164412045
Provider Name (Legal Business Name): TRAISMAN BENUCK TRAISMAN & MERENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HOWARD ST SUITE 203
EVANSTON IL
60202-3766
US

IV. Provider business mailing address

PO BOX 640
MATTESON IL
60443-0640
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-4300
  • Fax: 847-869-4330
Mailing address:
  • Phone: 708-747-5850
  • Fax: 708-747-9991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD S TRAISMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-869-4300