Healthcare Provider Details

I. General information

NPI: 1144072984
Provider Name (Legal Business Name): TROY MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 W BIG BEAVER RD STE 2020
TROY MI
48084-4925
US

IV. Provider business mailing address

755 W BIG BEAVER RD STE 2020
TROY MI
48084-4925
US

V. Phone/Fax

Practice location:
  • Phone: 248-749-3680
  • Fax:
Mailing address:
  • Phone: 248-749-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY CARPENTER
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-868-1563