Provider Demographics
NPI:1194736736
Name:GROSS POINTE UROLOGIC SURGEONS
Entity type:Organization
Organization Name:GROSS POINTE UROLOGIC SURGEONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SECHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-773-6210
Mailing Address - Street 1:18325 E 10 MILE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18325 E 10 MILE RD
Practice Address - Street 2:STE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4990
Practice Address - Country:US
Practice Address - Phone:586-773-6300
Practice Address - Fax:586-773-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITM035307332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
2368478OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MI1313743Medicaid