Healthcare Provider Details

I. General information

NPI: 1871514091
Provider Name (Legal Business Name): UROLOGICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 CHESTER BLVD
RICHMOND IN
47374-1919
US

IV. Provider business mailing address

1485 CHESTER BLVD
RICHMOND IN
47374-1919
US

V. Phone/Fax

Practice location:
  • Phone: 765-962-8551
  • Fax: 765-966-8089
Mailing address:
  • Phone: 765-962-8551
  • Fax: 765-966-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number50002706A
License Number StateIN

VIII. Authorized Official

Name: DR. J. MICHAEL PEREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 765-962-8551