Individual provider Active NPI

Michael Anthony Traub, M.D.

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1689652356
Registry record updated Jun 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD.014217 Issued in LA
Practice address
711 Dr Michael Debakey Dr
Ste 200
Lake Charles, LA 70601-5785
Phone
(337) 436-6100
Fax
(337) 436-6190
NPI assigned
Jan 4, 2006
Last updated
Jun 19, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 014217 LA
Family Medicine Physician 207Q00000X MD.014217 LA Primary

Addresses

Primary practice location

711 Dr Michael Debakey Dr
Ste 200
Lake Charles, LA 70601-5785

Mailing address

919 Hidden RDG
6TH Floor
Irving, TX 75038-3813
Phone (469) 282-2625

Other identifiers 1

IdentifierTypeStateIssuer
1177253MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250910003177 LA Order and Referring Only - Family PracticePractitioner - Family Practice 9537222518

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
014217LAMDFamily Medicine Physician
MD.014217LAMDFamily Medicine Physician

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403136000000",
    "number": "1689652356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 HIDDEN RDG",
            "address_2": "6TH FLOOR",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750383813",
            "telephone_number": "469-282-2625",
            "fax_number": "469-282-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 DR MICHAEL DEBAKEY DR",
            "address_2": "STE 200",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015785",
            "telephone_number": "337-436-6100",
            "fax_number": "337-436-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAUB",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2014-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "014217",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.014217",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1177253",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.