Provider Demographics
NPI:1407867815
Name:TROMBLY, STEVEN DOUGLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DOUGLAS
Last Name:TROMBLY
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 1:5195 15 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-268-9000
Mailing Address - Fax:586-978-7000
Practice Address - Street 1:5195 15 MILE ROAD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-268-9000
Practice Address - Fax:586-978-7000
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI036680207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0105064482OtherBLUE CROSS BLUE SHIELD
MI0105064482OtherBLUE CROSS BLUE SHIELD
A78165Medicare UPIN