MEDICARE: DR. RENATA TRELA BRINDISE D.O.

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	207N00000X	Dermatology Physician	5101019182	MI

General Provider Information

NPI Number	:	1881972305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENATA TRELA BRINDISE D.O.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	2601 COMPASS RD STE 125
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8089
Country	:	US
Telephone Number	:	847-843-3376
Fax Number	:	847-998-8631

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	04/11/2024

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