Trebelhorn, Jack
Trebelhorn, Jack is an individual health care provider with primary practice located at 20952 E 12 Mile Rd Ste 200 , Saint Clair Shores MI 48081-3203. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Trebelhorn, Jack can be contacted via phone (586) 771-4820.Contact Information
Primary practice address
20952 E 12 Mile Rd Ste 200
Saint Clair Shores MI 48081-3203
Phone: (586) 771-4820
Fax: (303) 485-3377
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Urology | 208800000X | DR.0067578 | Colorado |
Profile Details
| NPI number | 1619331998 |
|---|---|
| LBN Legal business name | Trebelhorn, Jack |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 12th, 2016 |
| Last updated | Jun 9th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619331998 | NPPES |
| Michigan | MEDICAID | 1619331998 |
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