1366577942 NPI number — JASON CHRISTOPHER TRATECHAUD D.O.

Table of content: JASON CHRISTOPHER TRATECHAUD D.O. (NPI 1366577942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366577942 NPI number — JASON CHRISTOPHER TRATECHAUD D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRATECHAUD
Provider First Name:
JASON
Provider Middle Name:
CHRISTOPHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366577942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E. MICHIGAN AVE.
Provider Second Line Business Mailing Address:
SUITE 370
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48912-1897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-484-4451
Provider Business Mailing Address Fax Number:
517-484-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E. MICHIGAN AVE.
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48912-1897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-484-4451
Provider Business Practice Location Address Fax Number:
517-484-0291
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  5101015596 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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