Healthcare Provider Details

I. General information

NPI: 1396147930
Provider Name (Legal Business Name): PATRICK JOSEPH TROY AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD STE. 365
DETROIT MI
48236-2169
US

IV. Provider business mailing address

22201 MOROSS RD STE. 365
DETROIT MI
48236-2169
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4886
  • Fax: 313-343-4120
Mailing address:
  • Phone: 313-343-4886
  • Fax: 313-343-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704292714
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704292714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: