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General NPI Number Information
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NPI Number | 1053268508
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Entity Type | Organization
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Legal Business Name | MICHIGAN INSTITUTE OF UROLOGY, PC
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 29275 NORTHWESTERN HWY STE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1044
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Country | US
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Telephone | 586-771-4820
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Fax |
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Provider Business Mailing Address
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Address Line | 20952 E 12 MILE RD STE 200
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3203
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Country | US
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Telephone | 586-771-4820
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Fax | 586-771-7960
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | TRACY LEE MCAULEY
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Credential |
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Telephone | 586-771-4820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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