Provider Demographics
NPI:1407998834
Name:ASSOCIATED UROLOGICAL SPECIALISTS
Entity Type:Organization
Organization Name:ASSOCIATED UROLOGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-941-2960
Mailing Address - Street 1:812 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-2286
Practice Address - Country:US
Practice Address - Phone:815-941-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D86595Medicare UPIN
K23705Medicare UPIN
K23706Medicare UPIN
K23708Medicare UPIN
G17304Medicare UPIN
211476Medicare PIN
K23704Medicare UPIN
K23707Medicare UPIN
214362Medicare PIN