Healthcare Provider Details

I. General information

NPI: 1982756433
Provider Name (Legal Business Name): UROLOGIC CLINIC OF SOUTHEASTERN MICHIGAN PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 7 MILE RD STE 2700
LIVONIA MI
48152-1006
US

IV. Provider business mailing address

39000 7 MILE RD STE 2700
LIVONIA MI
48152-1006
US

V. Phone/Fax

Practice location:
  • Phone: 734-462-5858
  • Fax: 734-462-5860
Mailing address:
  • Phone: 734-462-5858
  • Fax: 734-462-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301061957
License Number StateMI

VIII. Authorized Official

Name: DR. JOHN FREDERCIK HARB
Title or Position: OWNER
Credential: MD
Phone: 734-462-5858