Provider Demographics
NPI:1972791549
Name:TROY FOOT AND ANKLE PC
Entity type:Organization
Organization Name:TROY FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-312-0767
Mailing Address - Street 1:4550 INVESTMENT DR STE 280
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6362
Mailing Address - Country:US
Mailing Address - Phone:248-312-0767
Mailing Address - Fax:248-312-0840
Practice Address - Street 1:4550 INVESTMENT DR
Practice Address - Street 2:STE 280
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6363
Practice Address - Country:US
Practice Address - Phone:248-312-0767
Practice Address - Fax:248-312-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS001984332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5096320001Medicare NSC