Provider Demographics
NPI:1639264344
Name:TRI-COUNTY MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:TRI-COUNTY MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:STOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-979-5100
Mailing Address - Street 1:37450 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-3503
Mailing Address - Country:US
Mailing Address - Phone:586-979-5100
Mailing Address - Fax:
Practice Address - Street 1:37450 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3503
Practice Address - Country:US
Practice Address - Phone:586-979-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO6168Medicare ID - Type Unspecified