Provider Demographics
NPI:1104011493
Name:TROY FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:TROY FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPRUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-312-0767
Mailing Address - Street 1:4550 INVESTMENT DR
Mailing Address - Street 2:STE 280
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6363
Mailing Address - Country:US
Mailing Address - Phone:248-312-0767
Mailing Address - Fax:248-312-0840
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:STE 280
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6363
Practice Address - Country:US
Practice Address - Phone:248-312-0767
Practice Address - Fax:248-312-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS001984213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N89650Medicare PIN