Organization
PROMEDICA GENITO-URINARY SURGEONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN KNUEVEN (SUPERVISOR)
(567) 585-1969
Entity
Organization
Contact information
Practice address
2120 W CENTRAL AVE, TOLEDO, OH 43606-3834
(419) 531-8558
(419) 531-8798
Mailing address
100 MADISON AVE, MSC-S38805, TOLEDO, OH 43604
(844) 373-0871
(419) 885-3921
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
OH
208800000X
Urology Physician
Primary
—
OH
363A00000X
Physician Assistant
—
OH
363L00000X
Nurse Practitioner
—
OH
367500000X
Certified Registered Nurse Anesthetist
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076667
—
OH
Enumeration date
10/17/2012
Last updated
10/12/2023
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