Individual
DR. JACK TREBELHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
(303) 485-3377
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
(303) 485-3377
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
DR.0067578
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619331998
—
MI
Enumeration date
04/12/2016
Last updated
06/09/2022
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