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General NPI Number Information
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NPI Number | 1790705572
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Entity Type | Organization
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Legal Business Name | UROLOGY ASSOC OF PORT HURON, P.C.
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1037 WATER ST SUITE 1
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City | PORT HURON
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State | MI
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Zip | 48060-4408
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Country | US
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Telephone | 810-984-4194
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Fax | 810-984-4674
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Provider Business Mailing Address
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Address Line | 1037 WATER ST SUITE 1
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City | PORT HURON
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State | MI
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Zip | 48060-4408
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Country | US
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Telephone | 810-984-4194
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Fax | 810-984-4674
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DORIS J ADAIR
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Credential |
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Telephone | 810-984-4194
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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 | MI
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