1730376955 NPI number — MONROE UROLOGY ASSOCIATES PLLC

Table of content: (NPI 1730376955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730376955 NPI number — MONROE UROLOGY ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE UROLOGY ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730376955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48161-7165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-243-9620
Provider Business Mailing Address Fax Number:
734-243-3565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 N MACOMB ST
Provider Second Line Business Practice Location Address:
SUITE #5
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48162-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-243-9620
Provider Business Practice Location Address Fax Number:
734-243-3565
Provider Enumeration Date:
10/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAIR
Authorized Official First Name:
RAMACHANDRAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-243-9620

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4387651 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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