Provider Demographics
NPI:1033273438
Name:UROLOGIC HEALTH OF EASTERN ALABAMA, P.C.
Entity Type:Organization
Organization Name:UROLOGIC HEALTH OF EASTERN ALABAMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:256-236-1500
Mailing Address - Street 1:901 LEIGHTON AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5704
Mailing Address - Country:US
Mailing Address - Phone:256-236-1500
Mailing Address - Fax:256-236-1599
Practice Address - Street 1:901 LEIGHTON AVE STE 504
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5704
Practice Address - Country:US
Practice Address - Phone:256-236-1500
Practice Address - Fax:256-236-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12173174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76460Medicare UPIN