Healthcare Provider Details

I. General information

NPI: 1144469883
Provider Name (Legal Business Name): MICHIGAN INSTITUTE OF UROLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13251 E 10 MILE RD STE 200
WARREN MI
48089-2076
US

IV. Provider business mailing address

20952 E 12 MILE RD SUITE 200
SAINT CLAIR SHORES MI
48081-3200
US

V. Phone/Fax

Practice location:
  • Phone: 586-758-0123
  • Fax: 586-758-5264
Mailing address:
  • Phone: 586-771-4820
  • Fax: 586-771-6620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALPHONSE M SANTINO
Title or Position: PRESIDENT
Credential: MD
Phone: 586-771-4820