Provider Demographics
NPI:1316924459
Name:TREECE, NANCY ANN (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:TREECE
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:DEPT 999360 PO BOX 33738
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3738
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:10201 E JEFFERSON AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3149
Practice Address - Country:US
Practice Address - Phone:313-821-3777
Practice Address - Fax:313-824-3777
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301052023OtherCONTROLLED SUBSTANCE
MI4502477Medicaid
F16377Medicare UPIN
MIP59670003Medicare PIN