Basic Information
| Provider Information | |||||||||
| NPI: | 1245238575 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIZ | ||||||||
| FirstName: | TROY | ||||||||
| MiddleName: | TOLOSA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 305 MEDIC WAY | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656534633 | ||||||||
| FaxNumber: | 7656530562 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 MEDIC WAY | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461352296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656534633 | ||||||||
| FaxNumber: | 7656530562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01048550A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 01048550A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200189050A | 05 | IN | MEDICAID |