MEDICARE: TREVOR 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	332BC3200X	Customized Equipment (DME)	TN001392	MI

General Provider Information

NPI Number	:	1679731426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREVOR NEAL DPM

Provider Business Mailing Address
First Line	:	PO BOX 730
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-0730
Country	:	US
Telephone Number	:
Fax Number	:

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

Authorized Official
Title or Position	:	FACILITY DIRECTOR
Name	:	PAULA HOLLISTER
Credential	:
Telephone Number	:	269-651-2320

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	06/23/2014

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1275592503 — DR. JAMES E PHILLIPS M.D.
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