| James J Boutrous, MD | |
|
20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081-3200 | |
| (586) 771-4820 | |
| (586) 771-6620 |
| Full Name | James J Boutrous |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 20952 E 12 Mile Rd, St Clair Shores, Michigan |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487619722 | NPI | - | NPPES |
| 101289 | Other | MI | PRIORITY HEALTH |
| 4522258 | Other | MI | AETNA |
| A75907 | Other | MI | HAP |
| 340017814 | Other | MI | RAILROAD MEDICARE |
| 2406964001 | Other | MI | CIGNA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 4301028307 (Michigan) | Primary |
| Entity Name | Michigan Institute Of Urology Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427027416 PECOS PAC ID: 1052223492 Enrollment ID: O20031125000770 |
| Mailing Address | Practice Location Address |
|---|---|
| James J Boutrous, MD 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081-3200 Ph: (586) 771-4820 | James J Boutrous, MD 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081-3200 Ph: (586) 771-4820 |
Brian V Guz, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081 Phone: 586-771-4820 Fax: 586-771-6620 | |
Alphonse M Santino, MD Urology Medicare: Medicare Enrolled Practice Location: 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081 Phone: 586-771-4820 Fax: 586-771-6620 | |
Shiva J Maralani, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081 Phone: 586-771-4820 Fax: 586-771-6620 | |
Valal K George, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081 Phone: 586-771-4820 Fax: 586-771-6620 | |
Juan Rene Frontera, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081 Phone: 586-771-4820 Fax: 586-771-6620 | |
Edward W Schervish, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 20952 E 12 Mile Rd, Suite 200, St Clair Shores, MI 48081 Phone: 586-771-4820 Fax: 586-771-6620 |