MEDICARE: PAUL MICHAEL TRINQUERO M.D.

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	207P00000X	Emergency Medicine Physician	125-066436	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1124417944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MICHAEL TRINQUERO M.D.

Provider Business Mailing Address
First Line	:	3117A N ORCHARD ST
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-6342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117A N ORCHARD ST
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-6342
Country	:	US
Telephone Number	:	678-920-2030
Fax Number	:

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

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	01/18/2017

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