Provider Demographics
NPI:1073566030
Name:TRETINYAK, ALEXANDER SPENCER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SPENCER
Last Name:TRETINYAK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1818 N MEADE ST
Mailing Address - Street 2:SUITE 240 WEST
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3454
Mailing Address - Country:US
Mailing Address - Phone:920-731-8131
Mailing Address - Fax:920-832-0444
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:SUITE 240 WEST
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-731-8131
Practice Address - Fax:920-832-0444
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI60546-202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery