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1427027416

NPI Code Detail

MEDICARE: MICHIGAN INSTITUTE OF UROLOGY PC

MEDICARE: MICHIGAN INSTITUTE OF UROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0101X	Anatomic Pathology Physician
2	2085R0001X	Radiation Oncology Physician	4301046765	MI
3	2085R0202X	Diagnostic Radiology Physician	4301038127	MI
4	2088P0231X	Pediatric Urology Physician
5	291U00000X	Clinical Medical Laboratory
6	332B00000X	Durable Medical Equipment & Medical Supplies
7	363L00000X	Nurse Practitioner
8	208800000X	Urology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB9133	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	340E062730	OTHER	MI	BCBSM
3	0E06273	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1427027416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN INSTITUTE OF UROLOGY PC

Provider Business Mailing Address
First Line	:	20952 12 MILE RD
Second Line	:	SUITE 200
City	:	ST CLAIR SHORES
State	:	MI
Zip	:	48081-3203
Country	:	US
Telephone Number	:	586-771-4820
Fax Number	:	586-771-7960

Provider Business Practice Location Address
First Line	:	20952 12 MILE RD
Second Line	:	SUITE 200
City	:	ST CLAIR SHORES
State	:	MI
Zip	:	48081-3203
Country	:	US
Telephone Number	:	586-771-4820
Fax Number	:	586-771-7960

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN V GUZ
Credential	:	MD
Telephone Number	:	586-771-4820

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/25/2025

Similar Medicare Providers

1346293412 — JOHN C PANOS MD
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-6620

1730393927 — MICHIGAN INSTITUTE OF UROLOGY PC
Practice Location Address:

20952 12 MILE ROAD , 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-9616

1245476670 — MICHIGAN INSTITUTE OF UROLOGY LABORATORY
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-6620

1053674101 — DR. ROBERT LEWIS ELGIN D.O.
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-6620

1033515036 — CARRIE L ANDERSON
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 586-771-6620

1619331998 — DR. JACK TREBELHORN MD
Practice Location Address:

20952 E 12 MILE RD STE 200
SAINT CLAIR SHORES, MI
48081-3203

Practice Phone: 586-771-4820
Practice Fax: 303-485-3377

Directions to “MICHIGAN INSTITUTE OF UROLOGY PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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