Provider Demographics
NPI:1144286253
Name:TRAD, MICHAEL JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:TRAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10816 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:WI
Mailing Address - Zip Code:54441-9049
Mailing Address - Country:US
Mailing Address - Phone:715-207-5586
Mailing Address - Fax:
Practice Address - Street 1:10816 W 11TH ST
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:WI
Practice Address - Zip Code:54441-9049
Practice Address - Country:US
Practice Address - Phone:715-207-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3042-035152W00000X, 152W00000X
IL047-931448152W00000X
IL047-931296152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT90753Medicare UPIN
WIT90753Medicare UPIN
ILK23084Medicare ID - Type UnspecifiedMEMB# (GRP #910370)