Healthcare Provider Details

I. General information

NPI: 1316035637
Provider Name (Legal Business Name): UROLOGY ASSOCIATES LTD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DELAFIELD STREET SUITE 207
WAUKESHA WI
53188
US

IV. Provider business mailing address

1111 DELAFIELD STREET SUITE 207
WAUKESHA WI
53188
US

V. Phone/Fax

Practice location:
  • Phone: 262-446-3593
  • Fax: 262-547-0379
Mailing address:
  • Phone: 262-446-3593
  • Fax: 262-547-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JON AUGER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 262-446-3593