MEDICARE: DR. JACQUELINE A TRESCHUK-BAHN MD

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	2085R0202X	Diagnostic Radiology Physician	036078816	IL
2	2085R0202X	Diagnostic Radiology Physician	2012029923	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000553574	OTHER	KY	BCBS ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578533840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE A TRESCHUK-BAHN MD

Provider Business Mailing Address
First Line	:	70 DOCTORS PARK
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4928
Country	:	US
Telephone Number	:	573-334-6071
Fax Number	:	573-334-4739

Provider Business Practice Location Address
First Line	:	70 DOCTORS PARK
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4928
Country	:	US
Telephone Number	:	573-334-6071
Fax Number	:	573-334-4739

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/04/2026

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