Organization
ADVANCED UROLOGIC SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID KNOWLES M.D. (OWNER)
(618) 244-4060
Entity
Organization
Contact information
Practice address
604 SEVILLE DR, MOUNT VERNON, IL 62864-7001
(618) 244-4060
(618) 244-4061
Mailing address
604 SEVILLE DR, MOUNT VERNON, IL 62864-7001
(618) 244-4060
(618) 244-4061
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036114878
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE2609
RAILROAD
IL
Enumeration date
09/20/2007
Last updated
04/29/2010
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