Basic Information
| Provider Information | |||||||||
| NPI: | 1922422997 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMEDICA GENITO-URINARY SURGEONS LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARIN V HOPPS MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE # 800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851969 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Practice Location | |||||||||
| Address1: | 7640 SYLVANIA AVE | ||||||||
| Address2: | SUITE L | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435609729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195171022 | ||||||||
| FaxNumber: | 4195171026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | KNUEVEN | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5675851969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.