Provider Demographics
NPI:1831367168
Name:METROPOLITAN UROLOGIC SPECIALISTS PA
Entity type:Organization
Organization Name:METROPOLITAN UROLOGIC SPECIALISTS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNOEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-999-7020
Mailing Address - Street 1:6025 LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-999-6938
Mailing Address - Fax:
Practice Address - Street 1:6025 LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-999-6938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCP2429OtherRR MEDICARE
MNC00559Medicare PIN