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General NPI Number Information
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NPI Number | 1114109204
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Entity Type | Organization
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Legal Business Name | OAK BROOK UROLOGY LTD
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/27/2019
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Provider Practice Location Address
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Address Line | 600 ENTERPRISE DR STE 218
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City | OAK BROOK
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State | IL
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Zip | 60523-4200
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Country | US
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Telephone | 630-990-4244
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Fax | 630-990-4245
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Provider Business Mailing Address
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Address Line | 600 ENTERPRISE DR STE 218
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City | OAK BROOK
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State | IL
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Zip | 60523-4200
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Country | US
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Telephone | 630-990-4244
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Fax | 630-990-4245
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARIF H AGHA
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Credential | MD
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Telephone | 630-990-4244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 036-097400
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License Number State | IL
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