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Organization
MICHIGAN INSTITUTE OF UROLOGY PC
Active
Organization
MICHIGAN INSTITUTE OF UROLOGY PC
Active
Parent organization
MICHIGAN INSTITUTE OF UROLOGY PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MICHIGAN INSTITUTE OF UROLOGY PC
Authorized official
ALPHONSE SANTINO MD (PRESIDENT)
(586) 771-4820
Entity
Organization
Contact information
Practice address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-7960
Mailing address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-7960
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB9133
RAILROAD MEDICARE
MI
Enumeration date
05/03/2007
Last updated
05/15/2008
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