Organization
PEDIATRIC UROLOGY OF MI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WORKMAN (OFFICE MANAGER)
(248) 519-0305
Entity
Organization
Contact information
Practice address
2221 LIVERNOIS RD STE 103, TROY, MI 48083-1603
(248) 519-0305
(248) 519-0315
Mailing address
2221 LIVERNOIS RD STE 103, TROY, MI 48083-1603
(248) 519-0305
(248) 519-0315
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
031012
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0F31834
BCBS
MI
Enumeration date
02/15/2008
Last updated
02/15/2008
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