Provider Demographics
NPI:1972976512
Name:ADVANCED UROLOGY INSTITUTE, LLC
Entity type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-391-6494
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-391-6494
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:2301 SE 3RD AVE
Practice Address - Street 2:BLDG 100, STE A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5105
Practice Address - Country:US
Practice Address - Phone:352-351-0029
Practice Address - Fax:352-840-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site