Basic Information
| Provider Information | |||||||||
| NPI: | 1215972575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROMBLEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | TRAVIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5232 SOCIALVILLE FOSTER RD | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450409302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133390800 | ||||||||
| FaxNumber: | 5133390790 | ||||||||
| Practice Location | |||||||||
| Address1: | 5232 SOCIALVILLE FOSTER RD | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450409302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133390800 | ||||||||
| FaxNumber: | 5133390790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 08/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35096197 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 101660519 | 05 | PA | MEDICAID | 3104938 | 05 | OH | MEDICAID |