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EDISON LAKES UROLOGY PLYMOUTH OFFICE NPI 1033388558


NPI Information

NPI: 1033388558
Provider Name: EDISON LAKES UROLOGY PLYMOUTH OFFICE
Classification: Urology - 208800000X
Entity Type: Organization
Address:
1919 LAKE AVE
SUITE 109
PLYMOUTH, IN
ZIP 46563
Phone: (574) 935-2138
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EDISON LAKES UROLOGY PLYMOUTH OFFICE is an urology in Plymouth, IN. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. EDISON LAKES UROLOGY PLYMOUTH OFFICE NPI is 1033388558. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1919 LAKE AVE
SUITE 109
PLYMOUTH, IN
ZIP 46563-830
Phone: (574) 935-2138
Fax: (574) 935-2136

The provider's authorized official is Darryl R Busby .
The authorized official title is Executive Administrator and has the following contact phone number (574) 296-3200.

The enumeration date for this NPI number is 2/28/2008 and was last updated on 5/30/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208800000XUrologyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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