MEDICARE: ASSOCIATED UROLOGICAL SPECIALISTS LLC

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

General Provider Information

NPI Number	:	1831231562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED UROLOGICAL SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	7340 W COLLEGE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7340 W COLLEGE DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1159
Country	:	US
Telephone Number	:	708-923-2400
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELIZA ROQUE
Credential	:
Telephone Number	:	708-608-2195

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	03/18/2020

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