Provider Demographics
NPI:1114036241
Name:GT UROLOGICAL, LLC
Entity Type:Organization
Organization Name:GT UROLOGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:612-379-3578
Mailing Address - Street 1:1313 5TH ST SE
Mailing Address - Street 2:SUITE 221
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4504
Mailing Address - Country:US
Mailing Address - Phone:612-379-3578
Mailing Address - Fax:612-379-3579
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:SUITE 221
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:612-379-3578
Practice Address - Fax:612-379-3579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6700564332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site