Provider Demographics
NPI:1235230194
Name:UROLOGY ASSOCIATES OF SOUTH FLORIDA PLC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF SOUTH FLORIDA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LICHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-955-6025
Mailing Address - Street 1:7280 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3422
Mailing Address - Country:US
Mailing Address - Phone:561-955-6025
Mailing Address - Fax:561-955-6069
Practice Address - Street 1:7280 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 305
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3422
Practice Address - Country:US
Practice Address - Phone:561-955-6025
Practice Address - Fax:561-955-6069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0068004208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty