Provider Demographics
NPI:1043322183
Name:TROCHLIL, GAROLD (PAC)
Entity type:Individual
Prefix:
First Name:GAROLD
Middle Name:
Last Name:TROCHLIL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9706
Mailing Address - Country:US
Mailing Address - Phone:517-625-5001
Mailing Address - Fax:
Practice Address - Street 1:3337 BRITTON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9706
Practice Address - Country:US
Practice Address - Phone:517-625-3004
Practice Address - Fax:517-625-5001
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN57610007Medicare ID - Type Unspecified
MIR65859Medicare UPIN