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General NPI Number Information
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NPI Number | 1699879718
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Entity Type | Organization
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Legal Business Name | UROLOGY ASSOC OF DECATUR LTD
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 W HAY ST SUITE 200
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City | DECATUR
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State | IL
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Zip | 62526
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Country | US
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Telephone | 217-877-8925
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Fax | 217-877-0020
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Provider Business Mailing Address
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Address Line | 302 W HAY ST SUITE 200
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City | DECATUR
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State | IL
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Zip | 62526
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Country | US
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Telephone | 217-877-8925
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Fax | 217-877-0020
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY R CANHAM
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Credential | MD
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Telephone | 217-877-8925
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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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Taxonomy #2
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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 | IL
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Taxonomy #3
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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 | IL
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