Provider Demographics
NPI:1063422558
Name:TREVETT, MILDRED T (MD)
Entity type:Individual
Prefix:DR
First Name:MILDRED
Middle Name:T
Last Name:TREVETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 CYPRESS CROSSING DR STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8600
Mailing Address - Country:US
Mailing Address - Phone:407-515-1507
Mailing Address - Fax:407-515-8555
Practice Address - Street 1:2000 CYPRESS CROSSING DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8600
Practice Address - Country:US
Practice Address - Phone:407-515-1507
Practice Address - Fax:407-515-8555
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLPENDINGMedicaid
G59460Medicare UPIN