Provider Demographics
NPI:1386609527
Name:UROLOGY ASSOCIATES OF SOUTH BEND, PC
Entity type:Organization
Organization Name:UROLOGY ASSOCIATES OF SOUTH BEND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:DEPAUW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-234-4100
Mailing Address - Street 1:707 CEDAR ST
Mailing Address - Street 2:SUITE #450
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2054
Mailing Address - Country:US
Mailing Address - Phone:574-234-4100
Mailing Address - Fax:
Practice Address - Street 1:707 CEDAR ST
Practice Address - Street 2:SUITE #450
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2054
Practice Address - Country:US
Practice Address - Phone:574-234-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0323020001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0323020001OtherDMERC LICENSE