Provider Demographics
NPI:1295734549
Name:BROWARD UROLOGY LLC
Entity type:Organization
Organization Name:BROWARD UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-499-7696
Mailing Address - Street 1:700 N HIATUS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5206
Mailing Address - Country:US
Mailing Address - Phone:954-499-7696
Mailing Address - Fax:954-499-7699
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-499-7696
Practice Address - Fax:954-499-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89935208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98445OtherBCBS
FLK7866Medicare PIN