Basic Information
| Provider Information | |||||||||
| NPI: | 1518027812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROPARTNERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3183 PAYSPHERE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606743183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084920502 | ||||||||
| FaxNumber: | 7084920565 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 S GREENLEAF ST | ||||||||
| Address2: | STE J | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475991111 | ||||||||
| FaxNumber: | 8475991148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2006 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 7084505055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 01635877 | 01 | IL | BLUE SHIELD | OTHER |