Provider Demographics
NPI:1285930016
Name:ADVANCED UROLOGY, LLC
Entity type:Organization
Organization Name:ADVANCED UROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:YALKUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-624-2442
Mailing Address - Street 1:2161 LEXINGTON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7952
Mailing Address - Country:US
Mailing Address - Phone:859-624-2442
Mailing Address - Fax:859-624-2443
Practice Address - Street 1:2161 LEXINGTON RD STE 2
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7952
Practice Address - Country:US
Practice Address - Phone:859-624-2442
Practice Address - Fax:859-624-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37296208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64050131Medicaid
KY64050131Medicaid
KYDR3142Medicare PIN
1275621Medicare PIN