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Individual
ROGER B TRAYCOFF
Active
Individual
ROGER B TRAYCOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036051951
IL
207RR0500X
Rheumatology Physician
Primary
036051951
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG
IL
01
—
029224
HEALTH ALLIANCE
IL
01
—
036051951
IL STATE LICENSE
IL
05
—
036051951
—
IL
01
—
08421024
BC/BS
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0949277
CLIA
IL
01
—
194883
PERSONAL CARE
IL
01
—
206164
HEALTHLINK
IL
01
—
CATERPILLAR
6394P
IL
01
—
CD7143
RR MEDICARE GROUP
IL
01
—
P00144541
RR MEDICARE PIN
IL
Enumeration date
08/09/2006
Last updated
12/16/2011
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