Organization Name: | ADVANCED UROLOGY ASSOCIATES SC |
NPI Number: | 1396758553 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY LEWIS (PRESIDENT) |
Mailing Address: | 1541 Riverboat Center Dr Joliet |
State: | IL US |
Postal Code: | 604319341 |
Phone Number: | 8157413825 |
Fax Number: | 8157413263 |
NPI Enumeration Date: | 08/15/2006 |
NPI Last Update Date: | 07/05/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 042003978 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |