MEDICARE: VINCENT C TRAYNELIS MD

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	207T00000X	Neurological Surgery Physician	27034	IA
2	207T00000X	Neurological Surgery Physician	036-122576	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27296	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1487647517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT C TRAYNELIS MD

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 970
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-6644
Fax Number	:	312-942-2176

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:	SUITE 970
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-942-6644
Fax Number	:	312-942-2176

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/26/2009

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Directions to “ VINCENT C TRAYNELIS MD” Practice Location

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