MEDICARE: UNIVERSITY UROLOGY

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1710910351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY UROLOGY

Provider Business Mailing Address
First Line	:	3800 WOODWARD AVE
Second Line	:	SUITE 702
City	:	DETROIT
State	:	MI
Zip	:	48201-2061
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 JOHN R ST
Second Line	:	SUITE 1021
City	:	DETROIT
State	:	MI
Zip	:	48201-2020
Country	:	US
Telephone Number	:	313-833-3320
Fax Number	:

Authorized Official
Title or Position	:	CHAIR
Name	:	MICHAEL CHER
Credential	:
Telephone Number	:	313-993-2846

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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Directions to “UNIVERSITY UROLOGY ” Practice Location

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