Healthcare Provider Details

I. General information

NPI: 1598082364
Provider Name (Legal Business Name): ALLIED UROLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 FAIR RD
SIDNEY OH
45365-8947
US

IV. Provider business mailing address

PO BOX 537
SIDNEY OH
45365-0537
US

V. Phone/Fax

Practice location:
  • Phone: 937-710-4510
  • Fax: 937-710-4776
Mailing address:
  • Phone: 937-710-4510
  • Fax: 937-710-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number34009725
License Number StateOH

VIII. Authorized Official

Name: FRANCIS N OGBOLU
Title or Position: OWNER
Credential: DO
Phone: 937-710-4510