Provider Demographics
NPI:1467561480
Name:UROLOGY SURGEONS PC
Entity Type:Organization
Organization Name:UROLOGY SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-949-4340
Mailing Address - Street 1:1000 E PARIS AVE SE STE 230
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3680
Mailing Address - Country:US
Mailing Address - Phone:616-949-4340
Mailing Address - Fax:616-949-4341
Practice Address - Street 1:1000 E PARIS AVE SE STE 230
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3680
Practice Address - Country:US
Practice Address - Phone:616-949-4340
Practice Address - Fax:616-949-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI340D160430OtherBCBSM
MICB0580OtherRAILROAD MEDICARE
MICB0580OtherRAILROAD MEDICARE