Provider Demographics
NPI:1558370114
Name:CASCADES UROLOGY P.C.
Entity Type:Organization
Organization Name:CASCADES UROLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AMBANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-782-0200
Mailing Address - Street 1:2800 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3608
Mailing Address - Country:US
Mailing Address - Phone:517-782-0200
Mailing Address - Fax:517-784-1894
Practice Address - Street 1:2800 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3608
Practice Address - Country:US
Practice Address - Phone:517-782-0200
Practice Address - Fax:517-784-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINA049295208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C84838Medicare ID - Type Unspecified