Provider Demographics
NPI:1124039508
Name:UROLOGY CENTER OF PALM BEACH P A
Entity Type:Organization
Organization Name:UROLOGY CENTER OF PALM BEACH P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAUDINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-615-1234
Mailing Address - Street 1:13005 SOUTHERN BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9231
Mailing Address - Country:US
Mailing Address - Phone:561-615-1234
Mailing Address - Fax:561-615-1411
Practice Address - Street 1:13005 SOUTHERN BLVD STE 135
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9231
Practice Address - Country:US
Practice Address - Phone:561-615-1234
Practice Address - Fax:561-615-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6353Medicare ID - Type Unspecified