Healthcare Provider Details

I. General information

NPI: 1114972965
Provider Name (Legal Business Name): UROPARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S NORTHWEST HWY STE 106
PARK RIDGE IL
60068-4262
US

IV. Provider business mailing address

350 S NORTHWEST HWY STE 106
PARK RIDGE IL
60068-4262
US

V. Phone/Fax

Practice location:
  • Phone: 847-470-1500
  • Fax: 847-470-1550
Mailing address:
  • Phone: 847-470-1500
  • Fax: 847-470-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD HARRIS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 708-450-5055