Healthcare Provider Details

I. General information

NPI: 1770210684
Provider Name (Legal Business Name): HMG UROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74785 US HIGHWAY 111 STE 101
INDIAN WELLS CA
92210-7129
US

IV. Provider business mailing address

PO BOX 841163
LOS ANGELES CA
90084-1163
US

V. Phone/Fax

Practice location:
  • Phone: 760-776-8989
  • Fax:
Mailing address:
  • Phone: 760-776-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN FELLER
Title or Position: PRESIDENT
Credential: MD
Phone: 760-275-7919