Provider Demographics
NPI:1245238575
Name:QUIZ, TROY TOLOSA (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:TOLOSA
Last Name:QUIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-2296
Mailing Address - Country:US
Mailing Address - Phone:765-653-4633
Mailing Address - Fax:765-653-0562
Practice Address - Street 1:305 MEDIC WAY
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-2296
Practice Address - Country:US
Practice Address - Phone:765-653-4633
Practice Address - Fax:765-653-0562
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048550A207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200189050AMedicaid
IN169240Medicare ID - Type Unspecified