Provider Demographics
NPI:1578028197
Name:PRODY UROLOGY, PLLC
Entity Type:Organization
Organization Name:PRODY UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRODROMOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BORBOROGLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-308-5060
Mailing Address - Street 1:575 S WICKHAM RD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-1170
Mailing Address - Country:US
Mailing Address - Phone:321-308-5060
Mailing Address - Fax:
Practice Address - Street 1:575 S WICKHAM RD STE B
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-1170
Practice Address - Country:US
Practice Address - Phone:321-308-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty