Provider Demographics
NPI:1427297100
Name:ASSOCIATED UROLOGICAL SPECIALISTS
Entity type:Organization
Organization Name:ASSOCIATED UROLOGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HRIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:708-581-7308
Mailing Address - Street 1:10400 SOUTHWEST HIGHWAY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415
Mailing Address - Country:US
Mailing Address - Phone:708-581-7308
Mailing Address - Fax:708-274-4027
Practice Address - Street 1:1020 E OGDEN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8609
Practice Address - Country:US
Practice Address - Phone:708-349-1630
Practice Address - Fax:708-349-9153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-096031208800000X
IL036-0623382088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232706OtherBCBS
IL02232706OtherBCBS
5433040004Medicare NSC
211475Medicare PIN