Healthcare Provider Details

I. General information

NPI: 1164415709
Provider Name (Legal Business Name): GAY D TREPANIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 E DIVISION ST SUITE 100
FOND DU LAC WI
54935-3748
US

IV. Provider business mailing address

481 E DIVISION ST SUITE 100
FOND DU LAC WI
54935-3748
US

V. Phone/Fax

Practice location:
  • Phone: 920-929-8120
  • Fax: 920-929-8126
Mailing address:
  • Phone: 920-929-8120
  • Fax: 920-929-8126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16852
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number16852
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: