Provider Demographics
NPI:1114109204
Name:OAK BROOK UROLOGY LTD
Entity Type:Organization
Organization Name:OAK BROOK UROLOGY LTD
Other - Org Name:MORRIS UROLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARIF
Authorized Official - Middle Name:H
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-990-4244
Mailing Address - Street 1:600 ENTERPRISE DR STE 218
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4200
Mailing Address - Country:US
Mailing Address - Phone:630-990-4244
Mailing Address - Fax:630-990-4245
Practice Address - Street 1:600 ENTERPRISE DR STE 218
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4200
Practice Address - Country:US
Practice Address - Phone:630-990-4244
Practice Address - Fax:630-990-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209701OtherMEDICARE PTAN MORRIS
ILIL3043OtherMEDICARE PTAN
F49900Medicare UPIN