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General NPI Number Information
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NPI Number | 1194807693
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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 | 10/20/2006
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 6900 ORCHARD LAKE ROAD SUITE 101
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3424
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Country | US
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Telephone | 248-539-9036
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Fax | 248-539-9267
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Provider Business Mailing Address
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Address Line | 20952 12 MILE ROAD SUITE 200
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City | ST. 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 | 586-771-6620
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | ROBERT R DILORETO
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Credential | MD
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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 | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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