Provider Demographics
NPI:1215960034
Name:UROLOGY SPECIALTY GROUP LLC
Entity type:Organization
Organization Name:UROLOGY SPECIALTY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONDHUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-661-9692
Mailing Address - Street 1:7000 SW 62ND AVE
Mailing Address - Street 2:STE. 340
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-661-9692
Mailing Address - Fax:305-667-0630
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:STE. 340
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-661-9692
Practice Address - Fax:305-667-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271579100Medicaid
FL271579109Medicaid
FL271579112Medicaid
FL271579108Medicaid
FLDD3820OtherRAILROAD MEDICARE
FL271579101Medicaid
FL271579103Medicaid
FL5636224OtherCIGNA
FL271579102Medicaid
FL271579113Medicaid
FL271579118Medicaid
FL74984OtherBLUE CROSS BLUE SHIELD
FL271579105Medicaid
FL271579110Medicaid
FL271579111Medicaid
FL271579114Medicaid
FL271579117Medicaid
FL271579116Medicaid
FL271579104Medicaid
FLDE4135OtherRAILROAD MEDICARE
FL271579107Medicaid
FL271579108Medicaid
FL271579100Medicaid