Provider Demographics
NPI:1518911973
Name:PAUL R TROOST DO PC
Entity Type:Organization
Organization Name:PAUL R TROOST DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROOST
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-296-2800
Mailing Address - Street 1:33089 GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-1501
Mailing Address - Country:US
Mailing Address - Phone:586-296-2800
Mailing Address - Fax:
Practice Address - Street 1:33089 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1501
Practice Address - Country:US
Practice Address - Phone:586-296-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5101012776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P18020Medicare ID - Type Unspecified