Provider Demographics
NPI:1770193450
Name:UROTELEMEDICINE LLC
Entity Type:Organization
Organization Name:UROTELEMEDICINE LLC
Other - Org Name:FLORIDA UROLOGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-206-7972
Mailing Address - Street 1:7300 N KENDALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7840
Mailing Address - Country:US
Mailing Address - Phone:786-270-3900
Mailing Address - Fax:305-925-8100
Practice Address - Street 1:8669 NW 36TH ST STE 325
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6698
Practice Address - Country:US
Practice Address - Phone:786-393-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty