MEDICARE: WOODFIELD UROLOGY PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician		IL

General Provider Information

NPI Number	:	1033160320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODFIELD UROLOGY PARTNERSHIP

Provider Business Mailing Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	BROCK #2005
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3311
Country	:	US
Telephone Number	:	847-364-4990
Fax Number	:	847-364-4993

Provider Business Practice Location Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	BROCK #2005
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3311
Country	:	US
Telephone Number	:	847-364-4990
Fax Number	:	847-364-4993

Authorized Official
Title or Position	:	PARTNER
Name	:	SAMUEL L FLASTER
Credential	:	MD
Telephone Number	:	847-364-4990

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	07/21/2022

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