Healthcare Provider Details

I. General information

NPI: 1114874633
Provider Name (Legal Business Name): MICHIGAN INSTITUTE OF UROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 E HILLS CT SE
GRAND RAPIDS MI
49546-6249
US

IV. Provider business mailing address

4047 E HILLS CT SE
GRAND RAPIDS MI
49546-6249
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-9577
  • Fax: 616-956-5988
Mailing address:
  • Phone: 616-956-9577
  • Fax: 616-956-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL HOLLANDER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 616-956-9577