MEDICARE: DR. ISAAC J TREJO D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	708	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023009891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAAC J TREJO D.P.M.

Provider Business Mailing Address
First Line	:	6400 INDUSTRIAL LOOP
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2452
Country	:	US
Telephone Number	:	414-423-4100
Fax Number	:	414-423-4134

Provider Business Practice Location Address
First Line	:	4100 S HOWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4410
Country	:	US
Telephone Number	:	414-483-5566
Fax Number	:	866-263-5456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	02/21/2008

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