Provider Demographics
NPI:1902875214
Name:TRAUTMANN, MARK EMIL
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EMIL
Last Name:TRAUTMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 CALLE REY GUSTAVO
Mailing Address - Street 2:LA VILLA DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3262
Mailing Address - Country:US
Mailing Address - Phone:787-274-0822
Mailing Address - Fax:787-296-2293
Practice Address - Street 1:373 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3721
Practice Address - Country:US
Practice Address - Phone:787-274-0822
Practice Address - Fax:787-296-2293
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12160207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89052Medicare PIN