Basic Information
| Provider Information | |||||||||
| NPI: | 1427297100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED UROLOGICAL SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10400 SOUTHWEST HIGHWAY | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | CHICAGO RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085817308 | ||||||||
| FaxNumber: | 7082744027 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 E OGDEN AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083491630 | ||||||||
| FaxNumber: | 7083499153 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2009 | ||||||||
| LastUpdateDate: | 06/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | HRIBAR | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7085817308 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 036-096031 | IL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | 036-062338 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | 02232706 | 01 | IL | BCBS | OTHER |