Provider Demographics
NPI:1659467892
Name:LODI UROLOGICAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:LODI UROLOGICAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:N.
Authorized Official - Middle Name:ERICK
Authorized Official - Last Name:ALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-368-6661
Mailing Address - Street 1:830 S HAM LN
Mailing Address - Street 2:SUITE 26
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-7510
Mailing Address - Country:US
Mailing Address - Phone:209-368-6661
Mailing Address - Fax:209-333-7655
Practice Address - Street 1:830 S HAM LN
Practice Address - Street 2:SUITE 26
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7510
Practice Address - Country:US
Practice Address - Phone:209-368-6661
Practice Address - Fax:209-333-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77184ZMedicaid
CA1016910001OtherDMERC/NORIDIAN
CA1016910001OtherDMERC/NORIDIAN