Organization
ANDERSON UROLOGIC ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDALL CHARLES BLAKE M.D. (PRESIDENT)
(765) 643-0766
Entity
Organization
Contact information
Practice address
141 W 22ND ST, SUITE 213, ANDERSON, IN 46016-4304
(765) 643-0766
(765) 640-2353
Mailing address
141 W 22ND ST, SUITE 213, ANDERSON, IN 46016-4304
(765) 643-0766
(765) 640-2353
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
50002645A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50002645A
LICENSE
IN
Enumeration date
02/24/2006
Last updated
08/22/2020
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