Healthcare Provider Details

I. General information

NPI: 1689630568
Provider Name (Legal Business Name): ROCHESTER UROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 WALTON BLVD SUITE 211
ROCHESTER HILLS MI
48307-6900
US

IV. Provider business mailing address

1202 WALTON BLVD SUITE 211
ROCHESTER HILLS MI
48307-6900
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-4699
  • Fax: 248-650-4696
Mailing address:
  • Phone: 248-650-4699
  • Fax: 248-650-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT A BADALAMENT
Title or Position: OWNER
Credential: MD
Phone: 248-650-4699