Provider Demographics
NPI:1679717771
Name:WEIRICK, TROY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:A
Last Name:WEIRICK
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 ARCADE AVE
Practice Address - Street 2:STE 400
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2487
Practice Address - Country:US
Practice Address - Phone:574-522-2284
Practice Address - Fax:574-522-3952
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068357A207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986180Medicaid
IN000000896990OtherBCBS BMG CONCORD SPECIALTY CLINIC
IN200986180Medicaid
IN000000851313OtherBCBS BMG NORTH CENTRAL CARDIOVASCULAR
IN000000896990OtherBCBS BMG CONCORD SPECIALTY CLINIC
IN236040043Medicare PIN
IN000000851313OtherBCBS BMG NORTH CENTRAL CARDIOVASCULAR
IN000000896990OtherBCBS BMG CONCORD SPECIALTY CLINIC