Provider Demographics
NPI:1538126578
Name:TREAKLE, KEVIN B (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:B
Last Name:TREAKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 WILD CHERRY RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1727
Mailing Address - Country:US
Mailing Address - Phone:828-252-9704
Mailing Address - Fax:
Practice Address - Street 1:41 OAKLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4820
Practice Address - Country:US
Practice Address - Phone:828-252-8885
Practice Address - Fax:828-252-9420
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB60532Medicare UPIN
NC2146494CMedicare PIN