=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245881374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER UROLOGY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2019
-----------------------------------------------------
Last Update Date | 04/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19020 FORT ST
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48193-6701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-651-7053
-----------------------------------------------------
Fax | 313-488-2566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7542 WYOMING ST
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48126-1690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-316-1967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAHEEN ALANEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-316-1967
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------