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General NPI Number Information
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NPI Number | 1982975645
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Entity Type | Organization
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Legal Business Name | TROY SURGICARE
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 02/24/2012
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Provider Practice Location Address
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Address Line | 230 W MAPLE RD
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City | TROY
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State | MI
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Zip | 48084-5471
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Country | US
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Telephone | 248-362-3338
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Fax | 248-362-3634
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Provider Business Mailing Address
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Address Line | 230 W MAPLE RD SUITE 101
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City | TROY
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State | MI
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Zip | 48084-5471
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Country | US
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Telephone | 248-362-3338
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Fax | 248-362-3634
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Authorized Official
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Title or Position | FACILITY DIRECTOR
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Name | JAN BERNOT
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Credential |
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Telephone | 248-362-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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