Provider Demographics
NPI:1063625382
Name:PREFERRED UROLOGY CONSULTANTS, P.C
Entity type:Organization
Organization Name:PREFERRED UROLOGY CONSULTANTS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-353-3060
Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-353-3060
Mailing Address - Fax:248-353-0312
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 460
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-353-3060
Practice Address - Fax:248-353-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049075208800000X
MI4301067706208800000X
MI4301062234208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1215919048OtherNPI JAMES D RELLE MD
MI1326020157OtherNPI MICHAEL D LUTZ
MI3406361441OtherBCBS FOR MICHAEL D LUTZ
MI1831171669OtherNPI BRIAN D SEIFMAN MD
MI2758760Medicaid
MI3406361431OtherBCBS FOR BRIAN SEIFMAN
MI4301067706OtherLICENSE BRIAN SEIFMAN MD
MI4513238Medicaid
MI3406361451OtherBCBS FOR JAMES D RELLE
MI2995460Medicaid
MI4301049075OtherLICENSE MICHAEL D LUTZ MD
MI4301062234OtherLICENSE JAMES D RELLE MD
MIF70791Medicare UPIN
MI2758760Medicaid
P43980002Medicare PIN
MI4301067706OtherLICENSE BRIAN SEIFMAN MD
MI1326020157OtherNPI MICHAEL D LUTZ
MIB44501Medicare UPIN
0P43980Medicare PIN