Basic Information
| Provider Information | |||||||||
| NPI: | 1710306055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREADO | ||||||||
| FirstName: | GREGORY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 N CENTER ST | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480671710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482276345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25650 OUTER DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481462096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133831897 | ||||||||
| FaxNumber: | 3133836018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 5101021277 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1710306055 | 05 | MI | MEDICAID |