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General NPI Number Information
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NPI Number | 1063625382
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Entity Type | Organization
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Legal Business Name | PREFERRED UROLOGY CONSULTANTS, P.C
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 29201 TELEGRAPH RD SUITE 460
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1331
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Country | US
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Telephone | 248-353-3060
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Fax | 248-353-0312
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Provider Business Mailing Address
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Address Line | 29201 TELEGRAPH RD SUITE 460
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1331
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Country | US
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Telephone | 248-353-3060
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Fax | 248-353-0312
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL DAVID LUTZ
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Credential | M.D.
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Telephone | 248-353-3060
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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 | 4301049075
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301067706
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301062234
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License Number State | MI
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