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NPI Code Detail

MEDICARE: DR. TREVOR D. TREDENNICK M.D.

MEDICARE: DR. TREVOR D. TREDENNICK 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
1207P00000XEmergency Medicine Physician036-112632IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649264052
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TREVOR D. TREDENNICK M.D.
Provider Business Mailing Address
First Line : 1202 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2715
Country : US
Telephone Number : 208-365-3561
Fax Number :
Provider Business Practice Location Address
First Line : 1202 E LOCUST ST
Second Line :
City : EMMETT
State : ID
Zip : 83617-2715
Country : US
Telephone Number : 208-365-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2005
Last Update Date : 12/09/2022

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