Provider Demographics
NPI:1124156336
Name:ADVANCED UROLOGY LLC
Entity type:Organization
Organization Name:ADVANCED UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-802-9900
Mailing Address - Street 1:8091 TOWNSHIP LINE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2494
Mailing Address - Country:US
Mailing Address - Phone:317-802-9900
Mailing Address - Fax:317-802-9911
Practice Address - Street 1:8091 TOWNSHIP LINE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2494
Practice Address - Country:US
Practice Address - Phone:317-802-9900
Practice Address - Fax:317-802-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051162A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN234030Medicare PIN