Provider Demographics
NPI:1326189895
Name:ASSOCIATED UROLOGICAL SPECIALISTS
Entity Type:Organization
Organization Name:ASSOCIATED UROLOGICAL SPECIALISTS
Other - Org Name:SPECIALIZED UROLOGICAL CONSULTANTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KERMITT
Authorized Official - Middle Name:DAN
Authorized Official - Last Name:HOYME
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACS
Authorized Official - Phone:708-423-8706
Mailing Address - Street 1:4440 W 95TH ST STE 109-112
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-423-8706
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST STE 109-112
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-423-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C44170Medicare UPIN
K00586Medicare UPIN
G45114Medicare UPIN
G54736Medicare UPIN
C42567Medicare UPIN
211475Medicare PIN