MEDICARE: DR. TREVOR RICHARD NEAL DPM

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	001392	MI

General Provider Information

NPI Number	:	1255319059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR RICHARD NEAL DPM

Provider Business Mailing Address
First Line	:	102 S LAKEVIEW
Second Line	:	PO BOX 730
City	:	STURGIS
State	:	MI
Zip	:	49091
Country	:	US
Telephone Number	:	269-651-2320
Fax Number	:	269-659-4704

Provider Business Practice Location Address
First Line	:	102 S LAKEVIEW ST
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1947
Country	:	US
Telephone Number	:	269-651-2320
Fax Number	:	269-659-4704

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	01/16/2017

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