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Organization
ALLIANCE PHYSICIAN SERVICES OF MICHIGAN, P.C.
Active
Organization
ALLIANCE PHYSICIAN SERVICES OF MICHIGAN, P.C.
Active
Other names
Michigan Institute of Urology
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LEE MCAULEY (CREDENTIALING SUPERVISOR)
(586) 771-4820
Entity
Organization
Contact information
Practice address
20952 12 MILE RD, SUITE 200, ST CLAIR SHORES, MI 48081-3203
(586) 771-4820
(586) 771-7960
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
(586) 771-7960
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
—
NULL
207ZP0101X
Anatomic Pathology Physician
—
—
2085R0001X
Radiation Oncology Physician
4301046765
MI
2085R0202X
Diagnostic Radiology Physician
4301038127
MI
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
2088P0231X
Pediatric Urology Physician
—
NULL
2088P0231X
Pediatric Urology Physician
—
—
291U00000X
Clinical Medical Laboratory
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0E06273
BCBSM
MI
01
—
340E062730
BCBSM
MI
01
—
CB9133
RAILROAD MEDICARE
MI
Enumeration date
03/14/2006
Last updated
09/01/2026
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