Provider Demographics
NPI:1598759243
Name:TREISMAN, EDWARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:TREISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3857 LAKELAND LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1328
Mailing Address - Country:US
Mailing Address - Phone:248-737-0206
Mailing Address - Fax:248-737-0206
Practice Address - Street 1:3857 LAKELAND LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1328
Practice Address - Country:US
Practice Address - Phone:248-737-0206
Practice Address - Fax:248-737-0206
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301021308208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI471730910Medicaid
MI0F36469014Medicare ID - Type Unspecified
MI471730910Medicaid