Provider Demographics
NPI:1467172528
Name:UROLOGY ASSOCIATES OF GREEN BAY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF GREEN BAY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMAYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-676-2882
Mailing Address - Street 1:720 S VANBUREN STREET
Mailing Address - Street 2:STE 301
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-433-9400
Mailing Address - Fax:920-455-9409
Practice Address - Street 1:1385 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9366
Practice Address - Country:US
Practice Address - Phone:920-433-9400
Practice Address - Fax:920-455-9409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY ASSOCIATES OF GREEN BAY, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty