Provider Demographics
NPI:1740237007
Name:BAY AREA UROLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:BAY AREA UROLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-0322
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-2010
Mailing Address - Country:US
Mailing Address - Phone:231-935-0322
Mailing Address - Fax:231-935-0334
Practice Address - Street 1:3922 CEDAR RUN RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9687
Practice Address - Country:US
Practice Address - Phone:231-935-0322
Practice Address - Fax:231-935-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P02720Medicare ID - Type UnspecifiedPA GROUP ID
MI0M61460Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER