MEDICARE: GAVIN TROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1548142771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAVIN TROY

Provider Business Mailing Address
First Line	:	2920 ROSLYN TRL
Second Line	:
City	:	LONG BEACH
State	:	IN
Zip	:	46360-1726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 ROSLYN TRL
Second Line	:
City	:	LONG BEACH
State	:	IN
Zip	:	46360-1726
Country	:	US
Telephone Number	:	219-229-8817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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Directions to “ GAVIN TROY ” Practice Location

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