MICHIGAN UROLOGICAL CLINIC NPI 1376586164

NPI Information

  • NPI: 1376586164
  • Provider Name: MICHIGAN UROLOGICAL CLINIC
  • Classification: Urology - 208800000X
  • Entity Type: Organization
  • CLIA Number: 23D0380898
  • Address: 4047 SALADIN DR SE
    GRAND RAPIDS, MI
    ZIP 49546
  • Phone: (616) 956-9577

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NPI Details

MICHIGAN UROLOGICAL CLINIC is an urology in Grand Rapids, MI. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. MICHIGAN UROLOGICAL CLINIC NPI is 1376586164. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4047 SALADIN DR SE
GRAND RAPIDS, MI
ZIP 49546-249
Phone: (616) 956-9577
Fax: (616) 956-3090

The provider's authorized official is Jill Maatman .
The authorized official title is Office Manager and has the following contact phone number (616) 956-9577.

The CLIA number assigned to this NPI record is 23D0380898 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/13/2006 and was last updated on 6/9/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrology696MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10N93770MEDICARE PIN
21376586164OTHERMICHIGANNPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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