Basic Information
| Provider Information | |||||||||
| NPI: | 1538347406 | ||||||||
| 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: | 606740031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084920502 | ||||||||
| FaxNumber: | 7084920565 | ||||||||
| Practice Location | |||||||||
| Address1: | 6440 GRAND AVE | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600315257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477828349 | ||||||||
| FaxNumber: | 8477828546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2008 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORAN | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7084920502 | ||||||||
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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 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 1912923269 | 01 | IL | TYPE 1 NPI | OTHER |