Provider Demographics
NPI:1821237314
Name:JOHN R TROTTER M D INC 11890 E WARREN AVE
Entity Type:Organization
Organization Name:JOHN R TROTTER M D INC 11890 E WARREN AVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:248-559-7730
Mailing Address - Street 1:20905 GREENFIELD RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5360
Mailing Address - Country:US
Mailing Address - Phone:248-559-7730
Mailing Address - Fax:
Practice Address - Street 1:20905 GREENFIELD RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5360
Practice Address - Country:US
Practice Address - Phone:248-559-7730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty