Provider Demographics
NPI:1154573442
Name:TRI-COUNTY UROLOGISTS P.C
Entity type:Organization
Organization Name:TRI-COUNTY UROLOGISTS P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:WADLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-261-7417
Mailing Address - Street 1:17405 HALL RD
Mailing Address - Street 2:STE B
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4061
Mailing Address - Country:US
Mailing Address - Phone:586-228-0150
Mailing Address - Fax:586-228-0154
Practice Address - Street 1:14800 FARMINGTON RD
Practice Address - Street 2:STE 108
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5461
Practice Address - Country:US
Practice Address - Phone:734-261-7401
Practice Address - Fax:734-261-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0425310003Medicare NSC