MEDICARE: DR. RANDALL TREADWELL M.D.

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	207Q00000X	Family Medicine Physician	F2073	TX
2	207Q00000X	Family Medicine Physician	R5P88	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	00PK61	OTHER	TX	MEDICARE PROVIDER NUMBER

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

General Provider Information

NPI Number	:	1538462346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL TREADWELL M.D.

Provider Business Mailing Address
First Line	:	11601 SHADOW CREEK PKWY
Second Line	:	#111-104
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	325-829-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	11601 SHADOW CREEK PKWY
Second Line	:	#111-104
City	:	PEARLAND
State	:	TX
Zip	:	77584-7283
Country	:	US
Telephone Number	:	325-829-0894
Fax Number	:

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

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	12/16/2010

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Directions to “ DR. RANDALL TREADWELL M.D.” Practice Location

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