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General NPI Number Information
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NPI Number | 1366465270
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Entity Type | Organization
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Legal Business Name | TROY FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 2041 E SQUARE LAKE RD SUITE 300
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City | TROY
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State | MI
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Zip | 48085
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Country | US
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Telephone | 248-813-0124
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Fax | 248-879-0148
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Provider Business Mailing Address
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Address Line | 2041 E SQUARE LAKE RD. SUITE 300
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City | TROY
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State | MI
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Zip | 48085
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Country | US
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Telephone | 248-813-0124
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Fax | 248-879-0148
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Authorized Official
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Title or Position | PHYSICIAN
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Name | STACEY BELTZ
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Credential | DO
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Telephone | 248-813-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SS072019
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License Number State | MI
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