Basic Information
| Provider Information | |||||||||
| NPI: | 1477648566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | URO SURGERY ASSOCIATES LLC | ||||||||
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| OtherOrganizationName: | UROLOGIC SPECIALISTS OF NORTHWEST INDIANA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 W LINCOLN HWY | ||||||||
| Address2: | SUITE 200W | ||||||||
| City: | SCHEREFVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463751683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199345300 | ||||||||
| FaxNumber: | 2199345389 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 W 84TH DR. | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464106248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197361255 | ||||||||
| FaxNumber: | 2197381276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | YALOWITZ | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2197361255 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.