Healthcare Provider Details

I. General information

NPI: 1508384819
Provider Name (Legal Business Name): MR. TROY WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD BLDG 32E
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

15279 DICKERSON DR
FENTON MI
48430-1601
US

V. Phone/Fax

Practice location:
  • Phone: 248-451-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number3201013410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: