Healthcare Provider Details

I. General information

NPI: 1851534903
Provider Name (Legal Business Name): JOHN R. TROTTER II MD MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 CADIEUX
DETROIT MI
48224-2273
US

IV. Provider business mailing address

20905 GREENFIELD RD SUITE 303
SOUTHFIELD MI
48075-5360
US

V. Phone/Fax

Practice location:
  • Phone: 313-417-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN R. TROTTER II
Title or Position: OWNER
Credential: M.D.
Phone: 248-559-7730