NPIMap

Organization Active NPI

Michigan Institute of Urology PC

  • Durable Medical Equipment & Medical Supplies
  • Troy, MI
National Provider Identifier
1962674499
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
4301090214 Issued in MI
Legal business name
MICHIGAN INSTITUTE OF UROLOGY PC
Practice address
130 Town Center Dr
Suite 200
Troy, MI 48084-1744
Phone
(248) 786-0464
Fax
(248) 786-0674
NPI assigned
Mar 25, 2008
Organization subpart
Yes
Parent organization
MICHIGAN INSTITUTE OF UROLOGY PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alphonse M Santino, MD
Title
President
Phone
(586) 771-4820

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X
Pediatric Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2088P0231X
Durable Medical Equipment & Medical Supplies 332B00000X 4301090214 MI Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

130 Town Center Dr
Suite 200
Troy, MI 48084-1744

Mailing address

20952 E 12 Mile Rd
Suite 200
Saint Clair Shores, MI 48081-3200
Phone (586) 771-4820

Other identifiers 3

IdentifierTypeStateIssuer
CB9133OtherMIRAILROAD MEDICARE
540E016120OtherMIBCBSM DME
340E062730OtherMIBCBSM

National Provider Directory

National Provider Directory
Tax ID family
Wayne Macomb Urolog24 organizations share this tax ID, including this one
Part of
Wayne Macomb Urolog

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1962674499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20952 E 12 MILE RD",
            "address_2": "SUITE 200",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813200",
            "telephone_number": "586-771-4820",
            "fax_number": "586-771-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 TOWN CENTER DR",
            "address_2": "SUITE 200",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841744",
            "telephone_number": "248-786-0464",
            "fax_number": "248-786-0674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN INSTITUTE OF UROLOGY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MICHIGAN INSTITUTE OF UROLOGY PC",
        "enumeration_date": "2008-03-25",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "SANTINO",
        "authorized_official_first_name": "ALPHONSE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-771-4820",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology, Pediatric Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4301090214",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB9133",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM DME",
            "identifier": "540E016120",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "340E062730",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.