Healthcare Provider Details

I. General information

NPI: 1336067347
Provider Name (Legal Business Name): PURELY VASECTOMIES IL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N CLARK ST STE 310-C
CHICAGO IL
60610-5467
US

IV. Provider business mailing address

330 W MONTEBELLO AVE
PHOENIX AZ
85013-1847
US

V. Phone/Fax

Practice location:
  • Phone: 844-667-7376
  • Fax:
Mailing address:
  • Phone: 844-667-7376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENT WOODMANSEE
Title or Position: EMPLOYEE
Credential: DMD
Phone: 602-799-2251