Provider Demographics
NPI:1689667735
Name:TROSTEL, STEVEN GLEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GLEN
Last Name:TROSTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 WALTER REED BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5727
Mailing Address - Country:US
Mailing Address - Phone:972-276-1751
Mailing Address - Fax:972-276-1334
Practice Address - Street 1:777 WALTER REED BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5727
Practice Address - Country:US
Practice Address - Phone:972-276-1751
Practice Address - Fax:972-276-1334
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5655174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036345903Medicaid
TX036345901Medicaid
TX8G0080OtherBLUE CROSS BLUE SHIELD TX
TX036345903Medicaid
TX8G0080OtherBLUE CROSS BLUE SHIELD TX