MEDICARE: TRAVIS A. TIRPAK APN-CNP

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	363L00000X	Nurse Practitioner	209011610	IL
2	363LF0000X	Family Nurse Practitioner	209011610	IL

General Provider Information

NPI Number	:	1013323690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS A. TIRPAK APN-CNP

Provider Business Mailing Address
First Line	:	2000 GREEN RD
Second Line	:	SUITE 300
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-1598
Country	:	US
Telephone Number	:	734-995-3764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 ERIE CT
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2519
Country	:	US
Telephone Number	:	708-763-6747
Fax Number	:

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

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	05/11/2026

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