Provider Demographics
NPI:1427088228
Name:TREACY, KEVIN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:TREACY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:324 W SUPERIOR ST
Mailing Address - Street 2:800 MEDICAL ARTS
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1701
Mailing Address - Country:US
Mailing Address - Phone:218-249-3570
Mailing Address - Fax:218-722-8582
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:800 MEDICAL ARTS
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1701
Practice Address - Country:US
Practice Address - Phone:218-249-3570
Practice Address - Fax:218-722-8582
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-12-08
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Provider Licenses
StateLicense IDTaxonomies
MN28594207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN337587100Medicaid
MN337587100Medicaid