Organization
MICHIGAN INSTITUTE OF UROLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LEE MCAULEY (CREDENTIALING SPECIALIST)
(586) 771-4820
Entity
Organization
Contact information
Practice address
2300 GENOA BUSINESS PARK DR STE 120, BRIGHTON, MI 48114-7368
(586) 771-4820
Mailing address
20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 48081-3203
(586) 771-4820
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
12/15/2023
Last updated
01/14/2025
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