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General NPI Number Information
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NPI Number | 1609064096
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Entity Type | Organization
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Legal Business Name | SUSAN TRESE MD PA
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 5068 W PLANO PARKWAY SUITE 300
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City | PLANO
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State | TX
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Zip | 75093
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Country | US
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Telephone | 972-381-4234
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Fax | 972-381-4234
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Provider Business Mailing Address
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Address Line | 5068 W PLANO PARKWAY SUITE 300
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City | PLANO
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State | TX
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Zip | 75093
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Country | US
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Telephone | 972-381-4234
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Fax | 972-381-4234
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. SUSAN TRESE
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Credential | MD
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Telephone | 972-381-4234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | J9480
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License Number State | TX
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