Provider Demographics
NPI:1316392251
Name:ADVANCED UROLOGY INSTITUTE LLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-205-8981
Mailing Address - Street 1:35095 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2686
Mailing Address - Country:US
Mailing Address - Phone:727-771-0600
Mailing Address - Fax:
Practice Address - Street 1:35095 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2686
Practice Address - Country:US
Practice Address - Phone:727-771-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED UROLOGY INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-28
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site