# MICHIGAN INSTITUTE OF UROLOGY PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MICHIGAN INSTITUTE OF UROLOGY PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1801018338
- **Legal business name:** MICHIGAN INSTITUTE OF UROLOGY PC
- **Authorized official:** ALPHONSE SANTINO MD (PRESIDENT)
- **Authorized official phone:** (586) 771-4820

## Contact information

- **Practice address:** 20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
- **Practice address phone:** (586) 771-4820
- **Practice address fax:** (586) 771-7960
- **Mailing address:** 20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
- **Mailing address phone:** (586) 771-4820
- **Mailing address fax:** (586) 771-7960

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 05/15/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CB9133 | RAILROAD MEDICARE | MI |