Provider Demographics
NPI:1689630568
Name:ROCHESTER UROLOGY PC
Entity Type:Organization
Organization Name:ROCHESTER UROLOGY PC
Other - Org Name:PROF CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BADALAMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-650-4699
Mailing Address - Street 1:1202 WALTON BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6900
Mailing Address - Country:US
Mailing Address - Phone:248-650-4699
Mailing Address - Fax:248-650-4696
Practice Address - Street 1:1202 WALTON BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6900
Practice Address - Country:US
Practice Address - Phone:248-650-4699
Practice Address - Fax:248-650-4696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF323590OtherBLUE CROSS BLUE SHIELD
MI1134790001Medicare NSC
ON91400Medicare ID - Type Unspecified