Provider Demographics
NPI:1972639524
Name:UNIVERSITY UROLOGISTS ASSOCIATES PC
Entity Type:Organization
Organization Name:UNIVERSITY UROLOGISTS ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYED PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:VELJI
Authorized Official - Middle Name:K
Authorized Official - Last Name:KANSARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-347-8130
Mailing Address - Street 1:41935 W 12 MILE
Mailing Address - Street 2:STE 303
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-347-8130
Mailing Address - Fax:
Practice Address - Street 1:41935 W 12 MILE
Practice Address - Street 2:STE 303
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-347-8130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON67410Medicare ID - Type Unspecified