Provider Demographics
NPI:1245341973
Name:ADVANCED UROLOGY ASSOCIATES
Entity type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-319-3098
Mailing Address - Street 1:PO BOX 242121
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-9044
Mailing Address - Country:US
Mailing Address - Phone:414-319-3098
Mailing Address - Fax:
Practice Address - Street 1:2311 N PROSPECT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4445
Practice Address - Country:US
Practice Address - Phone:414-319-3098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty