Organization
LAKE UROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKI ORR (BILLER)
(219) 836-6241
Entity
Organization
Contact information
Practice address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 736-0616
Mailing address
PO BOX 3060, MUNSTER, IN 46321-0060
(219) 836-6241
(219) 836-2433
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01036410A
IN
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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