Provider Demographics
NPI:1861569170
Name:TRAPP MEDICAL ASSOCIATES, S.C.
Entity type:Organization
Organization Name:TRAPP MEDICAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:TRAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-935-1100
Mailing Address - Street 1:70 MEADOWVIEW CTR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2047
Mailing Address - Country:US
Mailing Address - Phone:815-935-1100
Mailing Address - Fax:815-937-5966
Practice Address - Street 1:70 MEADOWVIEW CTR
Practice Address - Street 2:SUITE 303
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2047
Practice Address - Country:US
Practice Address - Phone:815-929-9395
Practice Address - Fax:815-929-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095931208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095931Medicaid
ILDF2933OtherRR MEDICARE GROUP
IL04632084OtherBCBS IL
IL04632084OtherBCBS IL
ILG55040Medicare UPIN