Provider Demographics
NPI:1023283868
Name:STEVEN D TROMBLY MD PC
Entity type:Organization
Organization Name:STEVEN D TROMBLY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TROMBLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-268-9000
Mailing Address - Street 1:5195 15 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-268-9000
Mailing Address - Fax:586-978-7000
Practice Address - Street 1:5195 15 MILE ROAD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-268-9000
Practice Address - Fax:586-978-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI036680208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010564482OtherBLUE CROSS BLUE SHIELD PIN
MI0506448Medicare PIN
MIA78165Medicare UPIN