Healthcare Provider Details

I. General information

NPI: 1447862073
Provider Name (Legal Business Name): WINDHAM AND RENTROP UROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 HIGHWAY 182 W STE B
STARKVILLE MS
39759-9013
US

IV. Provider business mailing address

1207 HIGHWAY 182 W STE B
STARKVILLE MS
39759-9013
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1717
  • Fax: 601-944-9780
Mailing address:
  • Phone: 662-324-1097
  • Fax: 662-324-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONACIANA COLEMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-324-1097