Provider Demographics
NPI:1144397266
Name:TRANTUM, DENNIS A (MA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:A
Last Name:TRANTUM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3566 CAPITAL SW
Mailing Address - Street 2:#100
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015
Mailing Address - Country:US
Mailing Address - Phone:269-979-6455
Mailing Address - Fax:269-979-6458
Practice Address - Street 1:3566 CAPITAL SW
Practice Address - Street 2:#100
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-979-6455
Practice Address - Fax:269-979-6458
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000142231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540A30601OtherBLUE CROSS
MI540A30601OtherBLUE CROSS