Organization
MICHIGAN INSTITUTE OF UROLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT R DILORETO MD (PRESIDENT AND CEO)
(586) 771-4820
Entity
Organization
Contact information
Practice address
1701 SOUTH BLVD E, SUITE 340, ROCHESTER HILLS, MI 48307-6122
(248) 293-1000
(248) 293-1001
Mailing address
20952 E 12 MILE RD, SUITE 200, SAINT CLAIR SHORES, MI 48081-3200
(586) 771-4820
(586) 771-6620
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
2088P0231X
Pediatric Urology Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
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
06/10/2008
Last updated
01/14/2025
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