1063625382 NPI number — PREFERRED UROLOGY CONSULTANTS, P.C

Table of content: (NPI 1063625382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063625382 NPI number — PREFERRED UROLOGY CONSULTANTS, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED UROLOGY CONSULTANTS, P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063625382
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29201 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 460
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-353-3060
Provider Business Mailing Address Fax Number:
248-353-0312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29201 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-353-3060
Provider Business Practice Location Address Fax Number:
248-353-0312
Provider Enumeration Date:
05/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUTZ
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-353-3060

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  4301049075 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 4301062234 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: 4301067706 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215919048 . This is a "NPI JAMES D RELLE MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1326020157 . This is a "NPI MICHAEL D LUTZ" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3406361441 . This is a "BCBS FOR MICHAEL D LUTZ" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1831171669 . This is a "NPI BRIAN D SEIFMAN MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2758760 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3406361431 . This is a "BCBS FOR BRIAN SEIFMAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301067706 . This is a "LICENSE BRIAN SEIFMAN MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4513238 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3406361451 . This is a "BCBS FOR JAMES D RELLE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2995460 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4301049075 . This is a "LICENSE MICHAEL D LUTZ MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301062234 . This is a "LICENSE JAMES D RELLE MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com