Individual
DAVID TREVISAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSOP, CO
Contact information
Practice address
1407 E MICHIGAN AVE, JACKSON, MI 49202-3517
(517) 784-1142
Mailing address
1407 E MICHIGAN AVE, JACKSON, MI 49202-3517
(517) 784-1142
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222Z00000X
—
MI
Enumeration date
08/07/2017
Last updated
07/21/2022
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