Provider Demographics
NPI:1952544496
Name:TREESE, THEODORE ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ROBERT
Last Name:TREESE
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 1:1900 GLADES RD STE 500
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8508
Mailing Address - Country:US
Mailing Address - Phone:561-756-8734
Mailing Address - Fax:855-931-9090
Practice Address - Street 1:1900 GLADES ROAD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-756-8734
Practice Address - Fax:855-931-9090
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00916932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry