Healthcare Provider Details

I. General information

NPI: 1518687227
Provider Name (Legal Business Name): MICHIGAN HEALTHCARE PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31157 WOODWARD AVENUE
ROYAL OAK MI
48073
US

IV. Provider business mailing address

31157 WOODWARD AVENUE
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-336-0123
  • Fax:
Mailing address:
  • Phone: 248-336-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD KORMAN
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 248-336-0123