Healthcare Provider Details

I. General information

NPI: 1477117265
Provider Name (Legal Business Name): TREVOR TOOLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45816 SCHOENHERR RD
SHELBY TWP MI
48315-6028
US

IV. Provider business mailing address

26211 CENTRAL PARK BLVD STE 201
SOUTHFIELD MI
48076-4158
US

V. Phone/Fax

Practice location:
  • Phone: 586-842-2400
  • Fax: 586-991-6054
Mailing address:
  • Phone: 833-667-3627
  • Fax: 248-327-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4351044192
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: