Provider Demographics
NPI:1740232701
Name:TROY GASTROENTEROLOGY, PC
Entity Type:Organization
Organization Name:TROY GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SANTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOLOGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-844-9710
Mailing Address - Street 1:50438 VAN DYKE AVE
Mailing Address - Street 2:#B
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1358
Mailing Address - Country:US
Mailing Address - Phone:586-726-8423
Mailing Address - Fax:586-726-8557
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 270
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-844-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TROY GASTROENTEROLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDF4836OtherMEDICARE RAILROAD
MI0P34420Medicare PIN