Provider Demographics
NPI:1255319059
Name:NEAL, TREVOR RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:RICHARD
Last Name:NEAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S LAKEVIEW
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091
Mailing Address - Country:US
Mailing Address - Phone:269-651-2320
Mailing Address - Fax:269-659-4704
Practice Address - Street 1:102 S LAKEVIEW ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1947
Practice Address - Country:US
Practice Address - Phone:269-651-2320
Practice Address - Fax:269-659-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI001392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-2893651OtherEIN
T38016Medicare UPIN
MI5608480001Medicare NSC
MI4857550130Medicare PIN