Provider Demographics
NPI:1659476828
Name:MICHAEL L TREECE, MD, SC
Entity Type:Organization
Organization Name:MICHAEL L TREECE, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GUARDIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DEVRA
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:TREECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-534-5962
Mailing Address - Street 1:19 E SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-7049
Mailing Address - Country:US
Mailing Address - Phone:618-684-3342
Mailing Address - Fax:618-684-5647
Practice Address - Street 1:19 E SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-7049
Practice Address - Country:US
Practice Address - Phone:618-684-3342
Practice Address - Fax:618-684-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056536207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty