Provider Demographics
NPI:1518983998
Name:PEDIATRIC UROLOGY PARTNERS
Entity Type:Organization
Organization Name:PEDIATRIC UROLOGY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-297-8700
Mailing Address - Street 1:1440 RENAISSANCE DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1356
Mailing Address - Country:US
Mailing Address - Phone:847-297-8700
Mailing Address - Fax:847-297-8760
Practice Address - Street 1:1440 RENAISSANCE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1356
Practice Address - Country:US
Practice Address - Phone:847-297-8700
Practice Address - Fax:847-297-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360716442088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty