Provider Demographics
NPI:1285664391
Name:TROOST, PAUL R (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:TROOST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:330 W WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1035
Mailing Address - Country:US
Mailing Address - Phone:269-945-4220
Mailing Address - Fax:269-945-4229
Practice Address - Street 1:177 N BARLOW RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48740-9607
Practice Address - Country:US
Practice Address - Phone:989-736-8157
Practice Address - Fax:989-358-3762
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012776207Q00000X
WI48936-021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP46120Medicare PIN
MIP46120006Medicare UPIN
MIMI1503Medicare PIN
MIMI1504Medicare PIN
MIH41221Medicare UPIN
MIMI1504002Medicare UPIN
MIMI1503002Medicare UPIN