Healthcare Provider Details

I. General information

NPI: 1275840902
Provider Name (Legal Business Name): CHARLES C STROUD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 INVESTMENT DRIVE SUITE 240
TROY MI
48098
US

IV. Provider business mailing address

4550 INVESTMENT DR SUITE 240
TROY MI
48098-6363
US

V. Phone/Fax

Practice location:
  • Phone: 248-792-9881
  • Fax: 248-792-9895
Mailing address:
  • Phone: 248-792-9881
  • Fax: 248-792-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301059510
License Number StateMI

VIII. Authorized Official

Name: DR. CHARLES CHRISTOPHER STROUD
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 248-792-9881