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General NPI Number Information
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NPI Number | 1982756433
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Entity Type | Organization
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Legal Business Name | UROLOGIC CLINIC OF SOUTHEASTERN MICHIGAN PLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 39000 7 MILE RD STE 2700
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City | LIVONIA
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State | MI
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Zip | 48152-1006
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Country | US
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Telephone | 734-462-5858
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Fax | 734-462-5860
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Provider Business Mailing Address
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Address Line | 39000 7 MILE RD STE 2700
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City | LIVONIA
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State | MI
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Zip | 48152-1006
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Country | US
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Telephone | 734-462-5858
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Fax | 734-462-5860
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN FREDERCIK HARB
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Credential | MD
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Telephone | 734-462-5858
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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 | 4301061957
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License Number State | MI
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