Organization
CHILDRENS UROLOGY GROUP PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. THERESA KOLLNER (CREDENTIALING COORDINATOR)
(813) 874-7500
Entity
Organization
Contact information
Practice address
4712 N ARMENIA AVE, SUITE 200, TAMPA, FL 33603-2611
(813) 874-7500
(813) 877-1397
Mailing address
4712 N ARMENIA AVE, SUITE 200, TAMPA, FL 33603-2611
(813) 874-7500
(813) 877-1397
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
07/08/2015
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