Provider Demographics
NPI:1518936590
Name:ADVANCED UROGYNECOLOGY OF MICHIGAN, P.C.
Entity type:Organization
Organization Name:ADVANCED UROGYNECOLOGY OF MICHIGAN, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DOLLANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-982-0228
Mailing Address - Street 1:22731 NEWMAN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-982-0200
Mailing Address - Fax:313-982-0500
Practice Address - Street 1:22731 NEWMAN ST STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2023
Practice Address - Country:US
Practice Address - Phone:313-982-0200
Practice Address - Fax:313-982-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30520Medicare ID - Type Unspecified