Provider Demographics
NPI:1982770160
Name:TREMAINE, CHARLES LEO (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:LEO
Last Name:TREMAINE
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 1:1950 45TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3927
Mailing Address - Country:US
Mailing Address - Phone:219-924-6544
Mailing Address - Fax:219-922-8502
Practice Address - Street 1:1950 45TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3927
Practice Address - Country:US
Practice Address - Phone:219-924-6544
Practice Address - Fax:219-922-8502
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035537A207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100202530AMedicaid
IN100202530AMedicaid
D95525Medicare UPIN