Provider Demographics
NPI:1033323829
Name:METROPOLITAN UROLOGY PSC
Entity Type:Organization
Organization Name:METROPOLITAN UROLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-282-3899
Mailing Address - Street 1:10421 UNIVERSITY CENTER DR
Mailing Address - Street 2:SUITE 500H
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6427
Mailing Address - Country:US
Mailing Address - Phone:813-549-1055
Mailing Address - Fax:813-549-1051
Practice Address - Street 1:10421 UNIVERSITY CENTER DR
Practice Address - Street 2:SUITE 500H
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6427
Practice Address - Country:US
Practice Address - Phone:813-549-1055
Practice Address - Fax:813-549-1051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METROPOLITAN UROLOGY PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-10
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6289Medicare ID - Type Unspecified