Active NPI 1205215621 Individual Practitioner Male Practitioner

Dr. Alexander David Tapper , MD

Urology • Pontiac, MI

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Alexander Tapper, MD is a certified Urology practicing in Pontiac, MI. With approximately 11 years of clinical experience since graduating from Wayne State University School Of Medicine in 2015, Dr. Tapper delivers high-quality medical care to the local community at 44200 WOODWARD AVE STE 207.

Dr. Tapper is affiliated with Michigan Institute Of Urology Pc and accepts Medicare assignment.

Frequently performed procedures and clinical services include bcg live intravesical instillation, 1 mg, automated urinalysis test, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

44200 Woodward Ave Ste 207

Pontiac, MI 483415045

Telephone 2483226103

Fax 2486226108

Associated Practice Facility / Clinic

🏢 Michigan Institute Of Urology Pc Facility NPI 1881776383

Medicare Profile & Education

Medical School

Wayne State University School Of Medicine

Graduation Year

2015

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Pontiac, MI

Established Specialist (10-20 Yrs)

Practitioner Clinical Experience

11 Yrs -9.3 yrs vs City Avg

City Avg: 20.3 Yrs

State Avg: 25.6 Yrs

Regional Practice Density

3 Specialists

Practicing in Pontiac, MI (479 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

68.6% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Tapper (11 Years) 11 Yrs

Pontiac Specialty Average (20.3 Years) 20.3 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J9030 Bcg live intravesical instillation, 1 mg	2,400	17	$8.00	$2.88
81003 Automated urinalysis test	1,265	725	$6.73	$2.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	948	620	$380.57	$130.49
G2211 Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's	838	582	$50.00	$16.86
51798 Ultrasound measurement of bladder capacity after voiding	463	356	$33.91	$11.37
84153 Psa (prostate specific antigen) measurement, total	249	200	$54.36	$18.02
76770 Complete ultrasound scan behind abdominal cavity	241	131	$175.92	$50.36
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	174	38	$70.00	$64.50
99213 Established patient office or other outpatient visit, typically 15 minutes	173	138	$269.08	$92.16
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	127	127	$487.01	$170.73
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	115	69	$221.74	$81.03
80048 Blood test, basic group of blood chemicals (calcium, total)	107	82	$105.00	$8.29
51728 Complex measurement of pressure of urine flow in bladder with voiding pressure studies	103	103	$1060.63	$363.98
52000 Diagnostic exam of bladder and urethra using an endoscope	99	85	$650.00	$241.37
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	87	12	$700.00	$177.39
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	85	31	$55.00	$49.30
99442 Telephone medical discussion with physician, 11-20 minutes	81	73	$265.80	$91.41
84154 Psa (prostate specific antigen) measurement, free	76	68	$54.78	$18.02
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	68	20	$42.56	$14.54
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	59	56	$385.42	$134.90
51720 Instillation of anti-cancer drug into bladder	58	20	$225.00	$91.02
74420 Imaging of urinary tract	55	36	$229.91	$24.58
51784 Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings	54	54	$325.00	$33.16
76872 Ultrasound scan of pelvic region through rectum	47	47	$348.94	$136.46
84403 Testosterone (hormone) level, total	43	23	$76.26	$25.29
51700 Simple bladder irrigation and/or instillation	42	34	$175.00	$78.38
80076 Liver function blood test panel	40	21	$75.00	$8.01
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	38	21	$40.00	$7.61
83735 Magnesium level	36	15	$20.00	$6.57
84100 Phosphate level	36	15	$15.00	$4.65
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	32	25	$529.69	$185.81
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	32	24	$300.00	$122.42
57160 Fitting and insertion of vaginal support device	28	16	$228.00	$77.93
52332 Insertion of stent in urinary duct (ureter) using an endoscope	26	20	$951.92	$143.69
51705 Removal of skin suture with change of bladder tube	25	13	$288.28	$100.07
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	23	22	$475.00	$178.69
J1580 Injection, garamycin, gentamicin, up to 80 mg	23	12	$10.00	$2.51
76870 Ultrasound scan of scrotum	21	11	$113.43	$48.56
76775 Limited ultrasound scan behind abdominal cavity	19	11	$113.79	$27.30
51741 Electronic assessment of bladder emptying	18	18	$150.00	$14.65
52356 Crushing of stone of ureter with insertion of stent using an endoscope	16	13	$1500.00	$432.41
36415 Insertion of needle into vein for collection of blood sample	14	14	$10.00	$8.09
55700 Biopsy of prostate gland	11	11	$500.00	$248.21
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	11	11	$325.00	$58.92

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81003 Automated urinalysis test	1,103	578	$6.00	$2.18
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	799	482	$144.72	$129.67
51798 Ultrasound measurement of bladder capacity after voiding	405	248	$30.01	$10.78
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	221	140	$101.13	$82.02
99213 Established patient office or other outpatient visit, typically 15 minutes	212	159	$103.63	$92.74
84153 Psa (prostate specific antigen) measurement, total	197	153	$35.00	$17.94
76770 Complete ultrasound scan behind abdominal cavity	136	82	$146.81	$56.50
80048 Blood test, basic group of blood chemicals (calcium, total)	129	93	$105.00	$8.24
99442 Telephone medical discussion with physician, 11-20 minutes	115	99	$100.00	$92.30
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	110	110	$225.00	$170.20
52000 Diagnostic exam of bladder and urethra using an endoscope	108	93	$404.63	$247.70
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	99	19	$70.00	$64.21
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	96	93	$165.00	$135.50
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	68	12	$700.00	$171.24
74420 Imaging of urinary tract	66	50	$225.00	$24.85
51700 Simple bladder irrigation and/or instillation	64	52	$175.00	$78.83
84154 Psa (prostate specific antigen) measurement, free	57	53	$38.00	$18.02
80076 Liver function blood test panel	56	20	$75.00	$8.01
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	53	17	$28.00	$14.42
76775 Limited ultrasound scan behind abdominal cavity	45	26	$114.53	$27.63
51728 Complex measurement of pressure of urine flow in bladder with voiding pressure studies	44	43	$576.36	$358.58
51720 Instillation of anti-cancer drug into bladder	44	12	$225.00	$91.04
76872 Ultrasound scan of pelvic region through rectum	42	42	$300.00	$139.01
84403 Testosterone (hormone) level, total	42	22	$45.00	$24.98
84100 Phosphate level	41	19	$15.00	$4.65
83735 Magnesium level	41	19	$20.00	$6.57
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	39	22	$40.00	$7.61
52332 Insertion of stent in urinary duct (ureter) using an endoscope	28	25	$900.00	$133.01
57160 Fitting and insertion of vaginal support device	22	12	$120.00	$78.88
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	21	17	$204.29	$184.25
51702 Simple insertion of temporary bladder tube	19	14	$151.89	$63.52
52224 Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	18	15	$1925.00	$200.38
52356 Crushing of stone of ureter with insertion of stent using an endoscope	16	11	$1500.00	$432.09
82306 Vitamin d-3 level	15	11	$45.00	$29.01
36415 Insertion of needle into vein for collection of blood sample	13	11	$8.46	$7.32
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	11	11	$1500.00	$762.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81003 Automated urinalysis test	940	498	$6.00	$2.20
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	588	391	$135.00	$129.91
51798 Ultrasound measurement of bladder capacity after voiding	442	290	$30.00	$10.79
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	329	213	$100.00	$72.10
99213 Established patient office or other outpatient visit, typically 15 minutes	222	158	$95.00	$93.55
84153 Psa (prostate specific antigen) measurement, total	173	132	$35.00	$18.14
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	127	127	$225.00	$174.61
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	126	119	$165.00	$138.44
76770 Complete ultrasound scan behind abdominal cavity	107	77	$147.62	$63.17
52000 Diagnostic exam of bladder and urethra using an endoscope	93	81	$400.00	$250.78
80048 Blood test, basic group of blood chemicals (calcium, total)	77	63	$105.00	$8.34
99442 Telephone medical discussion with physician, 11-20 minutes	72	64	$98.89	$92.44
74420 Imaging of urinary tract	69	51	$225.00	$25.40
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	67	15	$28.00	$14.75
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	66	11	$700.00	$177.17
51700 Simple bladder irrigation and/or instillation	62	44	$175.00	$81.15
84154 Psa (prostate specific antigen) measurement, free	50	43	$38.00	$18.12
76872 Ultrasound scan of pelvic region through rectum	45	45	$300.00	$144.43
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	41	23	$66.34	$62.31
52332 Insertion of stent in urinary duct (ureter) using an endoscope	40	35	$900.00	$131.07
84100 Phosphate level	34	17	$15.00	$4.68
83735 Magnesium level	34	17	$20.00	$6.61
76775 Limited ultrasound scan behind abdominal cavity	34	24	$118.00	$28.90
51728 Complex measurement of pressure of urine flow in bladder with voiding pressure studies	29	29	$575.00	$387.22
80076 Liver function blood test panel	27	14	$75.00	$8.06
52356 Crushing of stone of ureter with insertion of stent using an endoscope	25	21	$1500.00	$437.20
51702 Simple insertion of temporary bladder tube	25	15	$150.00	$65.51
84403 Testosterone (hormone) level, total	24	15	$45.00	$25.51
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	24	16	$40.00	$7.67
52224 Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	18	17	$1925.00	$194.03
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	16	16	$1500.00	$728.60
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	15	14	$700.00	$338.45
76870 Ultrasound scan of scrotum	15	11	$120.27	$61.48
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	13	13	$145.00	$117.31
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	13	$70.00	$58.96
52351 Diagnostic examination of the bladder, bladder canal (urethra), and urinary duct (ureter) or kidney using an endoscope	12	11	$1000.00	$319.95
36415 Insertion of needle into vein for collection of blood sample	12	11	$5.00	$2.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81003 Automated urinalysis test	878	440	$6.00	$2.24
87798 Detection test for organism	663	46	$48.00	$35.09
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	543	331	$135.00	$132.33
87150 Identification of organisms by genetic analysis	440	37	$48.00	$35.09
51798 Ultrasound measurement of bladder capacity after voiding	402	254	$30.00	$10.58
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	256	166	$100.00	$73.50
99213 Established patient office or other outpatient visit, typically 15 minutes	236	183	$95.00	$93.11
84153 Psa (prostate specific antigen) measurement, total	185	141	$35.00	$18.23
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	115	115	$225.00	$171.06
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	112	104	$165.00	$139.47
87481 Detection test for candida species (yeast), amplified probe technique	102	46	$48.00	$35.09
76770 Complete ultrasound scan behind abdominal cavity	87	69	$162.50	$72.46
80048 Blood test, basic group of blood chemicals (calcium, total)	86	78	$105.00	$8.30
52000 Diagnostic exam of bladder and urethra using an endoscope	81	70	$400.00	$244.26
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	69	12	$700.00	$188.89
99442 Telephone medical discussion with physician, 11-20 minutes	61	52	$80.00	$80.00
51700 Simple bladder irrigation and/or instillation	57	41	$175.00	$82.73
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	56	15	$28.00	$14.50
74420 Imaging of urinary tract	53	39	$225.00	$25.54
87591 Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria)	51	46	$48.00	$35.09
87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique	51	46	$48.00	$35.09
87640 Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique	51	46	$48.00	$35.09
84154 Psa (prostate specific antigen) measurement, free	51	44	$38.00	$18.39
87653 Detection test by nucleic acid for strep (streptococcus, group b), amplified probe technique	51	46	$48.00	$35.09
87500 Detection test by nucleic acid for vancomycin resistance strep (vre), amplified probe technique	40	37	$48.00	$35.09
87641 Detection test by nucleic acid for staphylococcus aureus, methicillin resistant (mrsa bacteria), amplified probe technique	40	37	$48.00	$35.09
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	34	32	$70.00	$57.87
52332 Insertion of stent in urinary duct (ureter) using an endoscope	30	26	$900.00	$133.68
51702 Simple insertion of temporary bladder tube	25	13	$150.00	$66.20
J1580 Injection, garamycin, gentamicin, up to 80 mg	23	13	$10.00	$1.78
76775 Limited ultrasound scan behind abdominal cavity	23	17	$122.09	$30.05
U0003 Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r	22	19	$100.00	$75.00
52356 Crushing of stone of ureter with insertion of stent using an endoscope	21	14	$1500.00	$439.97
51728 Complex measurement of pressure of urine flow in bladder with voiding pressure studies	18	18	$549.72	$365.38
76872 Ultrasound scan of pelvic region through rectum	18	18	$269.44	$142.67
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	17	17	$150.00	$116.85
87186 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution	16	16	$11.75	$8.65
83735 Magnesium level	16	12	$20.00	$6.70
84100 Phosphate level	16	12	$15.00	$4.74
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	16	13	$40.00	$7.77
84403 Testosterone (hormone) level, total	15	13	$45.00	$25.81
36415 Insertion of needle into vein for collection of blood sample	15	15	$5.00	$3.00
80076 Liver function blood test panel	14	12	$75.00	$8.17
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	14	14	$325.00	$59.95
55700 Biopsy of prostate gland	13	13	$500.00	$262.06
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	13	12	$700.00	$327.20

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
81003 Automated urinalysis test	418	268	$6.00	$2.24
87798 Detection test for organism	325	24	$48.00	$35.09
51798 Ultrasound measurement of bladder capacity after voiding	248	176	$30.00	$10.48
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	241	190	$135.00	$111.92
87150 Identification of organisms by genetic analysis	220	20	$48.00	$35.09
99213 Established patient office or other outpatient visit, typically 15 minutes	112	91	$95.00	$77.78
84153 Psa (prostate specific antigen) measurement, total	74	71	$35.00	$18.39
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	73	56	$100.00	$72.83
80048 Blood test, basic group of blood chemicals (calcium, total)	50	48	$105.00	$8.33
87481 Detection test for candida species (yeast), amplified probe technique	50	24	$48.00	$35.09
52000 Diagnostic exam of bladder and urethra using an endoscope	45	44	$400.00	$215.90
51700 Simple bladder irrigation and/or instillation	43	33	$175.00	$79.00
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	43	41	$165.00	$145.34
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	40	40	$225.00	$171.81
74420 Imaging of urinary tract	31	24	$225.00	$25.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	28	28	$150.00	$108.77
87640 Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique	25	24	$48.00	$35.09
87491 Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique	25	24	$48.00	$35.09
87653 Detection test by nucleic acid for strep (streptococcus, group b), amplified probe technique	25	24	$48.00	$35.09
84154 Psa (prostate specific antigen) measurement, free	25	24	$38.00	$18.39
87591 Detection test for Neisseria gonorrhoeae (gonorrhoeae bacteria)	25	24	$48.00	$35.09
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	25	25	$173.00	$151.42
76770 Complete ultrasound scan behind abdominal cavity	22	22	$193.75	$89.44
87500 Detection test by nucleic acid for vancomycin resistance strep (vre), amplified probe technique	20	20	$48.00	$35.09
87641 Detection test by nucleic acid for staphylococcus aureus, methicillin resistant (mrsa bacteria), amplified probe technique	20	20	$48.00	$35.09
51728 Complex measurement of pressure of urine flow in bladder with voiding pressure studies	18	18	$540.00	$363.70
52332 Insertion of stent in urinary duct (ureter) using an endoscope	18	15	$900.00	$122.13
52356 Crushing of stone of ureter with insertion of stent using an endoscope	15	14	$1500.00	$452.92
99442 Telephone medical discussion with physician, 11-20 minutes	15	14	$80.00	$77.78
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	14	14	$700.00	$304.39
87186 Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution	13	12	$11.75	$8.65
76872 Ultrasound scan of pelvic region through rectum	12	12	$250.00	$146.39
52224 Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	11	11	$1925.00	$223.37

Medical Specialties & State Licenses

CMS Verified: 2020-07-08

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License MI 4301501984

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.

Hospital & Practice Group Affiliations

Michigan Institute Of Urology Pc

44200 Woodward Ave, Pontiac, MI 483415045

Phone: 2483226103

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Dr. Alec Wilson , MD

Urology

NPI 1801270327

Doctor of Medicine (M.D.)

Dr. Marko Gudziak , MD

Urology

NPI 1871558569

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

9 Historical Events

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2020

Urology (License #4301501984 in MI)

📍

Updated Practice Location May 13, 2020

Registered at 44200 WOODWARD AVE STE 207, PONTIAC, MI 483415045 (Tel: 2483226103)

📍

Updated Business Mailing Address May 13, 2020

Registered at 20952 E 12 MILE RD STE 200, SAINT CLAIR SHORES, MI 480813203 (Tel: 5867714820)

✅

NPI Profile Active May 19, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location May 19, 2015

Registered at 3601 W 13 MILE RD, ROYAL OAK, MI 480736712 (Tel: 2488985000)

📍

Updated Business Mailing Address May 19, 2015

Registered at 4497 CHERRY HILL DR W, ORCHARD LAKE, MI 483231615 (Tel: 3128980455)

👤

Provider Name / Credentials Updated May 19, 2015

Recorded as ALEXANDER TAPPER, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 19, 2015

Surgery (License #4301107565 in MI)

🟢

Initial NPI Registration & Enumeration May 19, 2015

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1205215621

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 19, 2015

Last Update: July 08, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

20952 E 12 Mile Rd Ste 200

Saint Clair Shores, MI 480813203

Phone: 5867714820

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.