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Organization

ILLINOIS UROLOGICAL INSTITUTE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MARTHA J TITINER MPH (PRACTICE MANAGER)
(630) 690-6400
Entity
Organization

Contact information

Practice address
311 SOUTH COUNTY FARM ROAD, SUITE B, WHEATON, IL 60187
(630) 690-6400
(630) 690-6482
Mailing address
311 SOUTH COUNTY FARM ROAD, SUITE B, WHEATON, IL 60187
(630) 690-6400
(630) 690-6482

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2201791
BLUECROSS BLUESHIELD
IL
Enumeration date
07/11/2006
Last updated
07/15/2016
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