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General NPI Number Information
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NPI Number | 1336067347
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Entity Type | Organization
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Legal Business Name | PURELY VASECTOMIES IL PLLC
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 1030 N CLARK ST STE 310-C
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City | CHICAGO
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State | IL
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Zip | 60610-5467
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Country | US
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Telephone | 844-667-7376
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Fax |
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Provider Business Mailing Address
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Address Line | 330 W MONTEBELLO AVE
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City | PHOENIX
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State | AZ
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Zip | 85013-1847
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Country | US
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Telephone | 844-667-7376
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | MR. BRENT WOODMANSEE
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Credential | DMD
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Telephone | 602-799-2251
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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 |
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License Number State |
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