Healthcare Provider Details

I. General information

NPI: 1265053029
Provider Name (Legal Business Name): HENRY M TRAURIG, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S CENTER ST
ROYAL OAK MI
48067-3230
US

IV. Provider business mailing address

10734 ELGIN AVE
HUNTINGTON WOODS MI
48070-1506
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-8533
  • Fax:
Mailing address:
  • Phone: 248-644-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY M TRAURIG
Title or Position: PRESIDENT
Credential: MA
Phone: 248-644-8533