Provider Demographics
NPI:1497816961
Name:FLORIDA UROLOGICAL INSTITUTE PA
Entity Type:Organization
Organization Name:FLORIDA UROLOGICAL INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:CAMUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-345-2274
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:110
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-345-2274
Mailing Address - Fax:727-381-1618
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:110
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-345-2274
Practice Address - Fax:727-381-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID NUMBER