Healthcare Provider Details

I. General information

NPI: 1619122884
Provider Name (Legal Business Name): UROLOGY ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 CHURCHILL ST SUITE 110
SHOREVIEW MN
55126-5868
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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