Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Jack Trebelhorn, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1619331998

Dr. Jack Trebelhorn, MD is an Urology in Saint Clair Shores, Michigan. Graduated from Medical College of Wisconsin in 2016, 10 years ago. Practices with Michigan Institute of Urology PC, a 83-clinician group and accepts Medicare assignment. Licensed in Colorado.

Years since qualifying
10
Trained at
Medical College of Wisconsin
Licensed in
CO
In the registry since
2016
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

20952 E 12 Mile Rd Ste 200
Saint Clair Shores, MI 48081-3203
Phone: (586) 771-4820
Fax: (303) 485-3377
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Urology Physician (primary) Taxonomy 208800000X · Licence DR.0067578 (CO)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1619331998
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 12, 2016
Last updated in NPPESJune 9, 2022
Certification dateJune 9, 2022
Mailing address20952 E 12 Mile Rd Ste 200, Saint Clair Shores, MI 48081-3203

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyUROLOGY
Medical schoolMEDICAL COLLEGE OF WISCONSIN
Graduated 2016 (10 years in practice)
Group practice Michigan Institute Of Urology Pc — 83 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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