Provider Demographics
NPI:1144369935
Name:MUIR, TRASKE MCNEIL (MD)
Entity type:Individual
Prefix:
First Name:TRASKE
Middle Name:MCNEIL
Last Name:MUIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100253
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0253
Mailing Address - Country:US
Mailing Address - Phone:801-568-5972
Mailing Address - Fax:844-249-1746
Practice Address - Street 1:4500 HOSPITAL BLVD STE 230
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0001
Practice Address - Country:US
Practice Address - Phone:470-956-4560
Practice Address - Fax:770-475-8968
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI83467207X00000X
ORMD217933207X00000X
UT8499823-1205207X00000X, 207XX0004X
GA103547207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265638357Medicaid