Provider Demographics
NPI:1699880591
Name:TROY GASTROENTEROLOGY, PC
Entity type:Organization
Organization Name:TROY GASTROENTEROLOGY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-726-8423
Mailing Address - Street 1:1650 RAMBLEWOOD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-7396
Mailing Address - Country:US
Mailing Address - Phone:517-332-1200
Mailing Address - Fax:517-351-7122
Practice Address - Street 1:1650 RAMBLEWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7396
Practice Address - Country:US
Practice Address - Phone:517-332-1200
Practice Address - Fax:517-351-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500C311470OtherBCBSM
MIOC31060OtherBCBSM
MIOC31060OtherBCBSM