Basic Information
| Provider Information | |||||||||
| NPI: | 1073536272 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY ASSOCIATES PC OF GRAND RAPIDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 CHERRY ST SE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164593551 | ||||||||
| FaxNumber: | 6164591060 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 CHERRY ST SE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164593551 | ||||||||
| FaxNumber: | 6164591060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | STEFFENS | ||||||||
| AuthorizedOfficialFirstName: | SHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6164593551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.