Basic Information
| Provider Information | |||||||||
| NPI: | 1114582541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAINOR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 E ONTARIO ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126947000 | ||||||||
| FaxNumber: | 3129266274 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 E ONTARIO ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126947000 | ||||||||
| FaxNumber: | 3129266274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2019 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085008285 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 10003391A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.