Provider Demographics
NPI:1114257540
Name:DYNAMIC UROCARE PC
Entity Type:Organization
Organization Name:DYNAMIC UROCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-662-1973
Mailing Address - Street 1:18100 OAKWOOD BLVD
Mailing Address - Street 2:STE 315
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-4085
Mailing Address - Country:US
Mailing Address - Phone:313-593-8057
Mailing Address - Fax:
Practice Address - Street 1:18100 OAKWOOD BLVD
Practice Address - Street 2:STE 315
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4085
Practice Address - Country:US
Practice Address - Phone:313-593-8057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301405433208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty