Healthcare Provider Details

I. General information

NPI: 1528232774
Provider Name (Legal Business Name): UROLOGY ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 OAKDALE AVE N SUITE 608
ROBBINSDALE MN
55422-2948
US

IV. Provider business mailing address

6525 FRANCE AVE S SUITE 200
EDINA MN
55435-2148
US

V. Phone/Fax

Practice location:
  • Phone: 763-520-7700
  • Fax:
Mailing address:
  • Phone: 952-927-6501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number130
License Number StateMN

VIII. Authorized Official

Name: BARBARA WEDEKIND
Title or Position: ADMINISTRATOR
Credential:
Phone: 952-927-6501