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General NPI Number Information
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NPI Number | 1326239526
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Entity Type | Organization
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Legal Business Name | UROLOGY CENTER, INC.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 398 W 80TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5432
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Country | US
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Telephone | 219-791-0615
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Fax | 219-791-0619
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Provider Business Mailing Address
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Address Line | 398 W 80TH PL
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City | MERRILLVILLE
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State | IN
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Zip | 46410-5432
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Country | US
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Telephone | 219-791-0615
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Fax | 219-791-0619
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Authorized Official
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Title or Position | OWNER
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Name | DR. AYOOLA K GOMIH
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Credential | M.D.
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Telephone | 219-791-0615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01032453A
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License Number State | IN
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