Provider Demographics
NPI:1558411512
Name:MICHIGAN UROLOGICAL INSTITUTE
Entity Type:Organization
Organization Name:MICHIGAN UROLOGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-569-0155
Mailing Address - Street 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-0155
Mailing Address - Fax:248-569-5226
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-0155
Practice Address - Fax:248-569-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRW045789208800000X
MIJS041027208800000X
MIPH063189208800000X
MIJO085172208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N91180Medicare ID - Type Unspecified