Provider Demographics
NPI:1134230345
Name:CHARLES CHRISTOPHER STROUD MD PC
Entity type:Organization
Organization Name:CHARLES CHRISTOPHER STROUD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-416-6260
Mailing Address - Street 1:4550 INVESTMENT DR STE 240
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6334
Mailing Address - Country:US
Mailing Address - Phone:248-792-9881
Mailing Address - Fax:248-792-9895
Practice Address - Street 1:4550 INVESTMENT DR STE 240
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6334
Practice Address - Country:US
Practice Address - Phone:248-792-9881
Practice Address - Fax:248-792-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059510207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI442725610Medicaid
G75762Medicare UPIN
MI442725610Medicaid
MI5425790001Medicare NSC