Provider Demographics
NPI:1407831365
Name:BURLINGTON UROLOGY PC
Entity Type:Organization
Organization Name:BURLINGTON UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRAMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MULLENGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-753-2747
Mailing Address - Street 1:400 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601
Mailing Address - Country:US
Mailing Address - Phone:319-753-2747
Mailing Address - Fax:319-752-4300
Practice Address - Street 1:400 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601
Practice Address - Country:US
Practice Address - Phone:319-753-2747
Practice Address - Fax:319-752-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA31796208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4517OtherBCBS
IA152454Medicaid
IA40017885OtherRR MEDICARE
IA4517OtherBCBS
IA152454Medicaid