Provider Demographics
NPI:1982649653
Name:TREAT, SIDNEY DANE (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:DANE
Last Name:TREAT
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 1:2501 E SOUTHERN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7666
Mailing Address - Country:US
Mailing Address - Phone:602-337-5609
Mailing Address - Fax:877-451-0270
Practice Address - Street 1:2501 E SOUTHERN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7666
Practice Address - Country:US
Practice Address - Phone:602-337-5609
Practice Address - Fax:877-451-0270
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33492207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ917502Medicaid
AZ917502Medicaid
AZ102462Medicare ID - Type Unspecified