# ALLIANCE PHYSICIAN SERVICES OF MICHIGAN, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Michigan Institute of Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427027416
- **Authorized official:** TRACY LEE MCAULEY (CREDENTIALING SUPERVISOR)
- **Authorized official phone:** (586) 771-4820

## Contact information

- **Practice address:** 20952 12 MILE RD, SUITE 200, ST CLAIR SHORES, MI 48081-3203
- **Practice address phone:** (586) 771-4820
- **Practice address fax:** (586) 771-7960
- **Mailing address:** 20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
- **Mailing address phone:** (586) 771-4820
- **Mailing address fax:** (586) 771-7960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0101X | Anatomic Pathology Physician | — | NULL | — |
| 207ZP0101X | Anatomic Pathology Physician | — | — | — |
| 2085R0001X | Radiation Oncology Physician | 4301046765 | MI | — |
| 2085R0202X | Diagnostic Radiology Physician | 4301038127 | MI | — |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |
| 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

- **Enumeration date:** 03/14/2006
- **Last updated:** 09/01/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0E06273 | BCBSM | MI |
| 01 | — | 340E062730 | BCBSM | MI |
| 01 | — | CB9133 | RAILROAD MEDICARE | MI |