Basic Information
| Provider Information | |||||||||
| NPI: | 1881858694 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAUGOTT | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3301 W FOREST HOME AVE | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532152843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146496000 | ||||||||
| FaxNumber: | 4146495296 | ||||||||
| Practice Location | |||||||||
| Address1: | 15855 19 MILE RD | ||||||||
| Address2: | |||||||||
| City: | CLINTON TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480383504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862632300 | ||||||||
| FaxNumber: | 3138761305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 683774 | TX | N | Nursing Service Providers | Licensed Practical Nurse | 363L00000X | L154631 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | AP11174 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 9826 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | AP116679 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 683774 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363L00000X | 4704351488 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1881858694 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | P00982598 | 01 | TX | MEDICARE RR | OTHER | P01254148 | 01 | TX | MEDICARE RR | OTHER | 282228004 | 05 | TX | MEDICAID | P01094717 | 01 | TX | RR MEDICARE | OTHER | 282228002 | 05 | TX | MEDICAID | 845N38 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 100096797 | 05 | WI | MEDICAID | 282228003 | 05 | TX | MEDICAID |