Provider Demographics
NPI:1316176183
Name:TRABADO, MARK J (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:TRABADO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1770 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-433-1539
Mailing Address - Fax:847-433-1552
Practice Address - Street 1:1770 1ST ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-433-1539
Practice Address - Fax:847-433-1552
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL041.311371367500000X
IL209007733367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered