MEDICARE: UROLOGY CONSULTANTS, INC.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1669403739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	33920 US HIGHWAY 19 N
Second Line	:	SUITE 241
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2654
Country	:	US
Telephone Number	:	727-785-6011
Fax Number	:	727-787-6951

Provider Business Practice Location Address
First Line	:	33920 US HIGHWAY 19 N
Second Line	:	SUITE 241
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-2654
Country	:	US
Telephone Number	:	727-785-6011
Fax Number	:	727-787-6951

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD BERGNER
Credential	:	MD
Telephone Number	:	727-785-6011

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	09/19/2007

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