Healthcare Provider Details

I. General information

NPI: 1982975645
Provider Name (Legal Business Name): TROY SURGICARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W MAPLE RD
TROY MI
48084-5471
US

IV. Provider business mailing address

230 W MAPLE RD SUITE 101
TROY MI
48084-5471
US

V. Phone/Fax

Practice location:
  • Phone: 248-362-3338
  • Fax: 248-362-3634
Mailing address:
  • Phone: 248-362-3338
  • Fax: 248-362-3634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAN BERNOT
Title or Position: FACILITY DIRECTOR
Credential:
Phone: 248-362-3338