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
JASON HAFRON MD (CHIEF MEDICAL OFFICER)
(586) 771-4820
Entity
Organization
Contact information
Practice address
130 TOWN CENTER DRIVE, SUITE 101, TROY, MI 48084-1773
(248) 740-0670
(248) 740-0668
Mailing address
20952 12 MILE ROAD, SUITE 200, ST. CLAIR SHORES, MI 48081-3203
(586) 771-4820
(586) 771-6620
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
—
2088P0231X
Pediatric Urology Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340E062730
BCBSM
MI
01
—
540E016120
BCBSM DME
MI
01
—
CB9133
RAILROAD MEDICARE
MI
Enumeration date
10/20/2006
Last updated
01/14/2025
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