Provider Demographics
NPI:1598865735
Name:UROLOGIC CONSULTANTS PLLC
Entity Type:Organization
Organization Name:UROLOGIC CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/O
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-459-4171
Mailing Address - Street 1:PO BOX 776432
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6432
Mailing Address - Country:US
Mailing Address - Phone:888-317-2911
Mailing Address - Fax:405-792-8910
Practice Address - Street 1:25 MICHIGAN ST NE
Practice Address - Street 2:SUITE 3300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2515
Practice Address - Country:US
Practice Address - Phone:616-459-4171
Practice Address - Fax:616-459-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16060OtherBLUE CROSS BLUE SHIEL
MI0D16060OtherBLUE CROSS BLUE SHIEL