Provider Demographics
NPI:1275840902
Name:CHARLES C STROUD MD PC
Entity Type:Organization
Organization Name:CHARLES C STROUD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-792-9881
Mailing Address - Street 1:4550 INVESTMENT DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6363
Mailing Address - Country:US
Mailing Address - Phone:248-792-9881
Mailing Address - Fax:248-792-9895
Practice Address - Street 1:4550 INVESTMENT DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098
Practice Address - Country:US
Practice Address - Phone:248-792-9881
Practice Address - Fax:248-792-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059510174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI442725610Medicaid
MI442725610Medicaid
MI0P00320Medicare PIN