Healthcare Provider Details

I. General information

NPI: 1740232701
Provider Name (Legal Business Name): TROY GASTROENTEROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR SUITE 270
TROY MI
48098-6365
US

IV. Provider business mailing address

50438 VAN DYKE AVE #B
SHELBY TOWNSHIP MI
48317-1358
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-9710
  • Fax:
Mailing address:
  • Phone: 586-726-8423
  • Fax: 586-726-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SANTE D BOLOGNA
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 248-844-9710