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NPI Code Detail

MEDICARE: AFFILIATED UROLOGISTS, LTD

MEDICARE: AFFILIATED UROLOGISTS, LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician22477AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194721530
Entity Type Code : Organization
Provider Name (Legal Business Name) : AFFILIATED UROLOGISTS, LTD
Provider Business Mailing Address
First Line : 500 W THOMAS RD
Second Line : STE 600
City : PHOENIX
State : AZ
Zip : 85013-4221
Country : US
Telephone Number : 602-264-0608
Fax Number : 602-234-0417
Provider Business Practice Location Address
First Line : 500 W THOMAS RD
Second Line : STE 600
City : PHOENIX
State : AZ
Zip : 85013-4221
Country : US
Telephone Number : 602-264-0608
Fax Number : 602-234-0417
Authorized Official
Title or Position : PRESIDENT/CEO
Name : STEPHEN HENRY PONAS
Credential : M.D.
Telephone Number : 602-264-0608
Provider Enumeration Date : 06/21/2005
Last Update Date : 08/22/2020

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