Provider Demographics
NPI:1770542078
Name:TREGER, KRISTEN L (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:TREGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:L
Other - Last Name:CASENAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12221 MERIT DR
Mailing Address - Street 2:STE 460
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:214-932-1860
Mailing Address - Fax:214-234-2762
Practice Address - Street 1:331 MELROSE DR., SUITE 220
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:469-828-1903
Practice Address - Fax:469-374-3851
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0070208D00000X
TX21591034207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151624702Medicaid
TX151624703Medicaid
TX151624703Medicaid
8F6692Medicare PIN
TX151624702Medicaid