Provider Demographics
NPI:1972589232
Name:ADVANCED UROLOGY, LTD.
Entity Type:Organization
Organization Name:ADVANCED UROLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:ELTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-410-8416
Mailing Address - Street 1:4959 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1537
Mailing Address - Country:US
Mailing Address - Phone:847-410-8416
Mailing Address - Fax:
Practice Address - Street 1:4959 GOLF RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1537
Practice Address - Country:US
Practice Address - Phone:847-410-8416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633701OtherBLUE CROSS / BLUE SHIELD
IL207411Medicare ID - Type Unspecified
IL210816Medicare ID - Type Unspecified