Healthcare Provider Details

I. General information

NPI: 1861569170
Provider Name (Legal Business Name): TRAPP MEDICAL ASSOCIATES, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MEADOWVIEW CTR SUITE 303
KANKAKEE IL
60901-2047
US

IV. Provider business mailing address

70 MEADOWVIEW CTR SUITE 303
KANKAKEE IL
60901-2047
US

V. Phone/Fax

Practice location:
  • Phone: 815-929-9395
  • Fax: 815-929-9396
Mailing address:
  • Phone: 815-935-1100
  • Fax: 815-937-5966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036095931
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036095931
License Number StateIL

VIII. Authorized Official

Name: DR. GREGORY TODD TRAPP
Title or Position: PRESIDENT
Credential: MD
Phone: 815-935-1100