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Individual

MR. TIMOTHY LEE TRAUGOTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ACNP

Contact information

Practice address
15855 19 MILE RD, CLINTON TOWNSHIP, MI 48038-3504
(586) 263-2300
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
683774
TX
363L00000X
Nurse Practitioner
4704351488
MI
363L00000X
Nurse Practitioner
9826
WI
363L00000X
Nurse Practitioner
AP11174
AZ
363L00000X
Nurse Practitioner
AP116679
TX
363L00000X
Nurse Practitioner
L154631
IA
363LA2100X
Acute Care Nurse Practitioner
0024177398
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
4704351488
MI
363LA2100X
Acute Care Nurse Practitioner
683774
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100096797
WI
01
1881858694
BLUE CROSS BLUE SHIELD
TX
05
282228002
TX
05
282228003
TX
05
282228004
TX
01
845N38
BLUE CROSS BLUE SHIELD
TX
01
P00982598
MEDICARE RR
TX
01
P01094717
RR MEDICARE
TX
01
P01254148
MEDICARE RR
TX
Enumeration date
07/11/2008
Last updated
12/05/2025
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