Organization Name: | UROLOGY OF INDIANA L.L.C. |
NPI Number: | 1003996638 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLEN A. BRUNK (M.D. / OWNER) |
Mailing Address: | 1101 W Jefferson St Suite U Franklin |
State: | IN US |
Postal Code: | 461312192 |
Phone Number: | 3177369487 |
Fax Number: | 3177369820 |
NPI Enumeration Date: | 10/17/2006 |
NPI Last Update Date: | 09/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |