Individual
JEFFREY DAVID TRACHTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-1722
(217) 464-1717
Mailing address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-1722
(217) 464-1717
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036103845
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI4811
MEDICARE TRAVELERS
—
Enumeration date
11/17/2005
Last updated
12/21/2021
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