Healthcare Provider Details

I. General information

NPI: 1699880591
Provider Name (Legal Business Name): TROY GASTROENTEROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 RAMBLEWOOD DR STE 100
EAST LANSING MI
48823-7396
US

IV. Provider business mailing address

1650 RAMBLEWOOD DR STE 100
EAST LANSING MI
48823-7396
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-1200
  • Fax: 517-351-7122
Mailing address:
  • Phone: 517-332-1200
  • Fax: 517-351-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY MICHALEK
Title or Position: BILLING MANAGER
Credential:
Phone: 586-726-8423