Healthcare Provider Details

I. General information

NPI: 1467561480
Provider Name (Legal Business Name): UROLOGY SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE STE 230
GRAND RAPIDS MI
49546-3680
US

IV. Provider business mailing address

1000 E PARIS AVE SE STE 230
GRAND RAPIDS MI
49546-3680
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-4340
  • Fax: 616-949-4341
Mailing address:
  • Phone: 616-949-4340
  • Fax: 616-949-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN ROHAN LOBO
Title or Position: CEO
Credential: MD
Phone: 616-949-4340