Provider Demographics
NPI:1215972575
Name:TROMBLEY, MICHAEL TRAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TRAVIS
Last Name:TROMBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 SOCIALVILLE FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9302
Mailing Address - Country:US
Mailing Address - Phone:513-339-0800
Mailing Address - Fax:513-339-0790
Practice Address - Street 1:5232 SOCIALVILLE FOSTER RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9302
Practice Address - Country:US
Practice Address - Phone:513-339-0800
Practice Address - Fax:513-339-0790
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35096197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101660519Medicaid
OH3104938Medicaid
PA101660519Medicaid
OH4306161Medicare PIN