Provider Demographics
NPI:1699778860
Name:TREISMAN, JONATHAN SCOTT (M D)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SCOTT
Last Name:TREISMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 W RAWSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8274
Mailing Address - Country:US
Mailing Address - Phone:414-427-2360
Mailing Address - Fax:414-427-6204
Practice Address - Street 1:7410 W RAWSON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8274
Practice Address - Country:US
Practice Address - Phone:414-427-2360
Practice Address - Fax:414-427-6204
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36866207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32158900Medicaid
WI000201522Medicare PIN
WIG10009Medicare UPIN
WI01097Medicare ID - Type Unspecified