Provider Demographics
NPI:1134180318
Name:TROY GASTROENTEROLOGY PC
Entity type:Organization
Organization Name:TROY GASTROENTEROLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
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:586-726-8423
Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:380
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5025
Mailing Address - Fax:
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:300
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:586-726-8423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100F31077OtherBLUE CROSS BLUE SHIELD MI
MI0M00540Medicare ID - Type Unspecified