Healthcare Provider Details

I. General information

NPI: 1285664391
Provider Name (Legal Business Name): PAUL R. TROOST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N BARLOW RD
HARRISVILLE MI
48740-9607
US

IV. Provider business mailing address

330 W WOODLAWN AVE
HASTINGS MI
49058-1035
US

V. Phone/Fax

Practice location:
  • Phone: 989-736-8157
  • Fax: 989-358-3762
Mailing address:
  • Phone: 269-945-4220
  • Fax: 269-945-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012776
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48936-021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: