Provider Demographics
NPI:1235833963
Name:MODERN UROLOGY PLLC
Entity Type:Organization
Organization Name:MODERN UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRONCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-558-4995
Mailing Address - Street 1:955 WHITE HAWK RANCH DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1683
Mailing Address - Country:US
Mailing Address - Phone:303-558-4995
Mailing Address - Fax:
Practice Address - Street 1:4943 STATE HWY 52 STE 180
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80514
Practice Address - Country:US
Practice Address - Phone:303-558-4995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty