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General NPI Number Information
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NPI Number | 1952544496
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Entity Type | Individual
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Provider Name | THEODORE ROBERT TREESE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 1900 GLADES ROAD
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City | BOCA RATON
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State | FL
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Zip | 33431
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Country | US
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Telephone | 561-756-8734
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Fax | 855-931-9090
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Provider Business Mailing Address
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Address Line | 1900 GLADES RD STE 500
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City | BOCA RATON
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State | FL
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Zip | 33431-8508
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Country | US
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Telephone | 561-756-8734
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Fax | 855-931-9090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | ME0091693
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License Number State | FL
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