Provider Demographics
NPI:1073537445
Name:SASSE, TROY JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:JOHN
Last Name:SASSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FOUNTAIN PLAZA
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-691-8838
Mailing Address - Fax:716-564-1134
Practice Address - Street 1:4827 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14043
Practice Address - Country:US
Practice Address - Phone:716-362-8777
Practice Address - Fax:716-671-8001
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266476207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0151200255OtherBCBS PIN
MI4529111Medicaid
MI0131682OtherPHP/IBA
H29526Medicare UPIN
MI0151200255OtherBCBS PIN
MI0A26057061Medicare PIN