Organization
FENTON CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH LAVERN TROLLMAN JR. DO (OWNER)
(810) 629-4187
Entity
Organization
Contact information
Practice address
201 E CAROLINE ST, 129, FENTON, MI 48430-2105
(810) 629-4187
(810) 629-9662
Mailing address
201 E CAROLINE ST, 129, FENTON, MI 48430-2105
(810) 629-4187
(810) 629-9662
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
51010055954
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0152524585
MR BC PPOM
MI
05
—
1001880
—
MI
Enumeration date
04/22/2008
Last updated
04/22/2008
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