Provider Demographics
NPI:1578886123
Name:TRELOAR, AARON KARL (IDC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:KARL
Last Name:TRELOAR
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 74TH ST UNIT E
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7540
Mailing Address - Country:US
Mailing Address - Phone:757-675-8873
Mailing Address - Fax:
Practice Address - Street 1:9930 74TH ST UNIT E
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7540
Practice Address - Country:US
Practice Address - Phone:757-675-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman