PEDIATRIC UROLOGY OF MI (NPI# 1356519920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356519920 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC UROLOGY OF MI |
| Practice Address |
2221 Livernois Rd Ste 103 Troy MI 48083-1603 |
| Practice Telephone | 2485190305 |
| Practice Fax Number | 2485190315 |
| Mailing Telephone | 2485190305 |
| Mailing Fax Number | 2485190315 |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-02-15 |
| Authorized Official Name | KIM WORKMAN (OFFICE MANAGER) |
| Authorized Official Telephone | 2485190305 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2088P0231X |
Urology Specialization: Pediatric Urology |
031012 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS | 0F31834 | 01 |
| Street Address |
2221 LIVERNOIS RD STE 103 |
| City | TROY |
| State | MI |
| Zip Code | 48083-1603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497874432 | Clare Jane Clor | Physical Therapist | 2221 Livernois Rd Ste 103, Troy, MI 48083-1603 | 2007-03-29 |
| 1619507878 | Team Rehabilitation Ty2, LLC | Physical Therapist | 2221 Livernois Rd Ste 103, Troy, MI 48083-1603 | 2020-01-16 |
| 1700385531 | Katherine Wells | Physical Therapist | 2221 Livernois Rd Ste 103, Troy, MI 48083-1603 | 2018-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417420449 | Thapasvi Muttirevula | Physical Therapist | 2422 Cedar Knoll Dr, Troy, MI 48083 | 2019-01-02 |
| 1114418290 | Ann Katchke | Physical Therapist | 3179 Livernois Rd, Troy, MI 48083 | 2018-05-23 |
| 1518485945 | Risa Rae Mendelson | Counselor | 1059 Owendale Street, Troy, MI 48083 | 2017-09-06 |
| 1497277115 | Gassan Asadi | Pharmacist | 215 E Big Beaver Rd Ste 500, Troy, MI 48083 | 2017-07-14 |
| 1528510328 | Dylan Skye Polasko | Behavioral Analyst | 2221 E 4th St, #101, Troy, MI 48083 | 2016-10-27 |
| 1235683061 | Sadia Ghazi | Technician, Other | 3178 Daley Dr., Troy, MI 48083 | 2016-08-10 |
| 1548664345 | Amber Leigh Ernst | Social Worker | 1225 E. Big Beaver Road, Troy, MI 48083 | 2014-10-22 |
| 1356782411 | Michelle Louise Knoblock | Nurse Anesthetist, Certified Registered | 1560 E Maple Rd Ste 100, Troy, MI 48083 | 2013-07-17 |
| 1437400728 | Oakland Physicians Surgery Center | Clinic/Center | 1560 E. Maple Road, Suite 100, Troy, MI 48083 | 2012-09-26 |
| 1861748238 | Pro Med Substance Abuse Program LLC | Psychologist | 2891 E. Maple Rd. Suite 200, Troy, MI 48083 | 2012-08-03 |
| Find all providers in zip 48083 | ||||
| Taxonomy Code | 2088P0231X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| Specialization | Pediatric Urology |
| Surgeons who can diagnose, treat, and manage children’s urinary and genital problems. A pediatric urologist devotes a minimum of 50% of his or her practice to the urologic problems of infants, children, and adolescents. Pediatric urologists generally provide the following services: the evaluation and management of voiding disorders; vesicoureteral reflux, and urinary tract infections that require surgery; surgical reconstruction of the urinary tract (kidneys, ureters, and bladder) including genital abnormalities, hypospadias, and intersex conditions; surgery for groin conditions in childhood and adolescence (undescended testes, hydrocele/hernia, varicocele). |
| Notes: Source: American Academy of Pediatrics [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770793325 | Henry Ford Health System | Urology | Vattikuti Urology Institute, K-9, Henry Ford Hospital, 2799 W. Bethune Avenue, Detroit, MI 48202 | 2007-05-23 |
| 1861457285 | Claude Reitelman | Urology | 263 Puritan Ave, Birmingham, MI 48009-4631 | 2006-04-19 |
| 1720073497 | Kirstan Kathleen Meldrum | Urology | 3875 Bay Rd Ste 25, Saginaw, MI 48603-2417 | 2005-09-19 |
| 1922233683 | Janae Preece | Urology | 3901 Beaubien St, Children's Hospital of Mi- Pediatric Urology, Detroit, MI 48201-2119 | 2009-05-26 |
| 1326208745 | Michigan Institute of Urology, PC | Urology | 1701 South Blvd E, Suite 340, Rochester Hills, MI 48307-6122 | 2008-06-10 |
| 1508900267 | Kristina D. Suson | Urology | 3901 Beaubien St, Pediatric Urology, Detroit, MI 48201-2119 | 2007-02-16 |
| 1750476859 | Joseph W Mashni | Urology | 1625 Ramblewood Dr, East Lansing, MI 48823-6367 | 2006-10-04 |
| 1376638429 | Lansing Institute of Urology, P.C. | Urology | 1625 Ramblewood Dr, East Lansing, MI 48823-6367 | 2006-10-04 |
| 1417042698 | Rafid H Yousif | Urology | 1625 Ramblewood Dr, East Lansing, MI 48823-6367 | 2006-10-04 |
| 1174618300 | Leonard J Zuckerman | Urology | 1625 Ramblewood Dr, East Lansing, MI 48823-6367 | 2006-10-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.