Provider Demographics
NPI:1407853443
Name:GENITO URINARY SURGEONS, INC.
Entity Type:Organization
Organization Name:GENITO URINARY SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMETT
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:419-531-8558
Mailing Address - Street 1:3500 EXECUTIVE PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1319
Mailing Address - Country:US
Mailing Address - Phone:419-531-8558
Mailing Address - Fax:419-531-8798
Practice Address - Street 1:3500 EXECUTIVE PKWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1319
Practice Address - Country:US
Practice Address - Phone:419-531-8558
Practice Address - Fax:419-531-8798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH404293208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0327720Medicaid
OH0327720Medicaid
OH0189180001Medicare NSC
OHGE9916132Medicare ID - Type Unspecified