Provider Demographics
NPI:1730393927
Name:MICHIGAN INSTITUTE OF UROLOGY PC
Entity type:Organization
Organization Name:MICHIGAN INSTITUTE OF UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALPHONSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-771-4820
Mailing Address - Street 1:20952 12 MILE ROAD
Mailing Address - Street 2:200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3203
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-9616
Practice Address - Street 1:20952 12 MILE ROAD
Practice Address - Street 2:200
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-3203
Practice Address - Country:US
Practice Address - Phone:586-771-4820
Practice Address - Fax:586-771-9616
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHIGAN INSTITUTE OF UROLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB9133OtherRAILROAD MEDICARE
MI340E062730OtherBCBSM
MI340E062730OtherBCBSM
MI0219690001Medicare NSC