# PRIME UROLOGY LTD

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

## Provider details

- **NPI number:** 1649702721
- **Authorized official:** ERNERSTO TAN M.D. (PRESIDENT)
- **Authorized official phone:** (815) 741-1020

## Contact information

- **Practice address:** 300 READ ST, STE A, LOCKPORT, IL 60441-3265
- **Practice address phone:** (815) 741-1020
- **Practice address fax:** (815) 221-4175
- **Mailing address:** 300 READ ST, STE A, LOCKPORT, IL 60441-3265
- **Mailing address phone:** (815) 741-1020
- **Mailing address fax:** (815) 221-4175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036049705 | IL | Yes |

## Other

- **Enumeration date:** 03/29/2017
- **Last updated:** 03/29/2017