Healthcare Provider Details

I. General information

NPI: 1952854853
Provider Name (Legal Business Name): UROLOGY SPECIALIST GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST SUITE 200
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

2140 W 68TH ST SUITE 200
HIALEAH FL
33016-1815
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-7227
  • Fax: 786-431-2075
Mailing address:
  • Phone: 305-822-7227
  • Fax: 786-431-2075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MS. YOLI ALMEYDA
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-822-7227