MEDICARE: MICHIGAN INSTITUTE OF UROLOGY LABORATORY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	4301070286	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	690E02750	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1245476670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN INSTITUTE OF UROLOGY LABORATORY

Provider Business Mailing Address
First Line	:	20952 E 12 MILE RD
Second Line	:	SUITE 200
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3200
Country	:	US
Telephone Number	:	586-771-4820
Fax Number	:	586-771-6620

Provider Business Practice Location Address
First Line	:	20952 E 12 MILE RD STE 200
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3203
Country	:	US
Telephone Number	:	586-771-4820
Fax Number	:	586-771-6620

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN GUZ
Credential	:	MD
Telephone Number	:	586-771-4820

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	09/10/2019

Similar Medicare Providers

1427027416 — MICHIGAN INSTITUTE OF UROLOGY PC
Practice Location Address:

20952 12 MILE RD , SUITE 200
ST CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-7960

1346293412 — JOHN C PANOS MD
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1730393927 — MICHIGAN INSTITUTE OF UROLOGY PC
Practice Location Address:

20952 12 MILE ROAD , 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-9616

1053674101 — DR. ROBERT LEWIS ELGIN D.O.
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-6620

1033515036 — CARRIE L ANDERSON
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

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Practice Fax: 586-771-6620

1619331998 — DR. JACK TREBELHORN MD
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 303-485-3377

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