Provider Demographics
NPI:1104920198
Name:TREEP, THERESA C (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:C
Last Name:TREEP
Suffix:
Gender:F
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:PO BOX 6328
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6328
Mailing Address - Country:US
Mailing Address - Phone:317-776-9214
Mailing Address - Fax:317-776-9219
Practice Address - Street 1:10017 WATER CREST DRIVE
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:317-776-9214
Practice Address - Fax:317-776-9219
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042463A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000217277OtherANTHEM