Provider Demographics
NPI:1265142129
Name:DOWN THERE UROLOGY, PLLC
Entity type:Organization
Organization Name:DOWN THERE UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-620-1803
Mailing Address - Street 1:20706 CARDINAL CT
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-3106
Mailing Address - Country:US
Mailing Address - Phone:312-620-1803
Mailing Address - Fax:
Practice Address - Street 1:1030 N CLARK ST STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5413
Practice Address - Country:US
Practice Address - Phone:312-620-1803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty