Provider Demographics
NPI:1508861089
Name:TREON, BRIAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:TREON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HOME ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-1407
Mailing Address - Country:US
Mailing Address - Phone:937-378-7780
Mailing Address - Fax:937-378-7792
Practice Address - Street 1:2000 GREEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1598
Practice Address - Country:US
Practice Address - Phone:734-995-3764
Practice Address - Fax:734-661-0730
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072342207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2035238Medicaid
IN200219250Medicaid
KY64962228Medicaid
OH0828002Medicare PIN
OHTR4257693Medicare PIN
OH4257692Medicare PIN
KY64962228Medicaid
IN200219250Medicaid