Healthcare Provider Details

I. General information

NPI: 1588807630
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: 04/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17401 W 12 MILE RD
LATHRUP VILLAGE MI
48076-2135
US

IV. Provider business mailing address

20905 GREENFIELD RD SUITE 303
SOUTHFIELD MI
48075-5360
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-8200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine 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