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Specialty details in registry · Troy, MI

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At a glance

171 Blanche Dr, Troy, MI 48098-2934

NPPES record updated Mar 8, 2017. Public records can lag behind changes at a practice.

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Practice location

171 Blanche Dr
Troy, MI 48098-2934

Professional details: NPI, taxonomy & registry record

NPI1063952166

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 261QR0208X
Enumeration date: Mar 8, 2017
Record updated: Mar 8, 2017

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

261QH0100X

License reported: 00080829 MI

Specialty details in registry

261QR0208X · Primary

License reported: 164498 MI

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

171 Blanche Dr
Troy, MI 48098-2934

Phone: (248) 703-4838

Mailing address

171 BLANCHE DR

TROY, MI 480982934

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

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