MEDICARE: MICHAEL A TRALLA 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	207Y00000X	Otolaryngology Physician	21450	CO

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

General Provider Information

NPI Number	:	1689715088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A TRALLA M.D.

Provider Business Mailing Address
First Line	:	3555 LUTHERAN PKWY
Second Line	:	STE 160
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6021
Country	:	US
Telephone Number	:	303-425-0449
Fax Number	:	303-425-0449

Provider Business Practice Location Address
First Line	:	3555 LUTHERAN PKWY W
Second Line	:	STE 160
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-6013
Country	:	US
Telephone Number	:	303-425-0449
Fax Number	:	303-425-0449

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/05/2011

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