Provider Demographics
NPI:1457457699
Name:MIAMI UROLOGIC INSTITUTE INC
Entity Type:Organization
Organization Name:MIAMI UROLOGIC INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARISTEDES
Authorized Official - Last Name:MEKRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:305-661-8977
Mailing Address - Street 1:7051 SW 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4701
Mailing Address - Country:US
Mailing Address - Phone:305-661-8977
Mailing Address - Fax:305-662-9123
Practice Address - Street 1:7051 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4701
Practice Address - Country:US
Practice Address - Phone:305-661-8977
Practice Address - Fax:305-662-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
72761Medicare ID - Type Unspecified