Provider Demographics
NPI:1467530493
Name:TROE, THEODORE E (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:E
Last Name:TROE
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:DEPARTMENT 4387
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4387
Mailing Address - Country:US
Mailing Address - Phone:630-355-0450
Mailing Address - Fax:630-527-3911
Practice Address - Street 1:801 S WASHINGTON STREET
Practice Address - Street 2:EDWARD HOSPITAL
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60566-7060
Practice Address - Country:US
Practice Address - Phone:630-355-0450
Practice Address - Fax:630-527-3911
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361066691Medicaid
ILK07409Medicare ID - Type Unspecified
IL0361066691Medicaid