# MICHIGAN UROLOGICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376586164
- **Authorized official:** MRS. JILL MAATMAN (OFFICE MANAGER)
- **Authorized official phone:** (616) 956-9577

## Contact information

- **Practice address:** 4047 SALADIN DR SE, GRAND RAPIDS, MI 49546-6249
- **Practice address phone:** (616) 956-9577
- **Practice address fax:** (616) 956-3090
- **Mailing address:** 4047 SALADIN DR SE, GRAND RAPIDS, MI 49546-6249
- **Mailing address phone:** (616) 956-9577
- **Mailing address fax:** (616) 956-3090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 696 | MI | Yes |

## Other

- **Enumeration date:** 06/13/2006
- **Last updated:** 06/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1376586164 | NPI | MI |