# LAKE REGION UROLOGY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306819230
- **Authorized official:** DR. WILLIAM HASTINGS FORESMAN M.D. (PRESIDENT)
- **Authorized official phone:** (315) 258-5253

## Contact information

- **Practice address:** 192 GENESEE ST, AUBURN, NY 13021-3361
- **Practice address phone:** (315) 258-5253
- **Practice address fax:** (315) 258-0202
- **Mailing address:** 192 GENESEE ST, AUBURN, NY 13021-3361
- **Mailing address phone:** (315) 258-5253
- **Mailing address fax:** (315) 258-0202

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 195558 | NY | Yes |

## Other

- **Enumeration date:** 02/10/2006
- **Last updated:** 06/19/2008