MEDICARE: DR. TERRY A TREADWELL MD

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	208600000X	Surgery Physician	11176	AL

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
2	1710077	OTHER	AL	UNITED HEALTH CARE
3	C71058	OTHER	AL	VIVA
4	203204949	OTHER	AL	FED TAX ID
5	203204949	OTHER	AL	HEALTH CHOICE
6	C71058 31984	OTHER	AL	BLUE CROSS SHIELD

General Provider Information

NPI Number	:	1376637025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY A TREADWELL MD

Provider Business Mailing Address
First Line	:	301 BROWN SPRINGS RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7005
Country	:	US
Telephone Number	:	334-747-4159
Fax Number	:

Provider Business Practice Location Address
First Line	:	2167 NORMANDIE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2728
Country	:	US
Telephone Number	:	334-747-3444
Fax Number	:	334-747-3450

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/06/2023

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Directions to “ DR. TERRY A TREADWELL MD” Practice Location

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