Basic Information
| Provider Information | |||||||||
| NPI: | 1235636846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TROSKY | ||||||||
| FirstName: | ELLIOTT | ||||||||
| MiddleName: | JORDAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 E 49TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462051047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175175631 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8414 NAAB RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462601972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173386399 | ||||||||
| FaxNumber: | 3173386359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2018 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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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 | 390200000X | IN | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.