Organization
MODERN UROLOGY GROUP LLC
Active
Other names
Modern Urology
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM MICHAEL DE FAZIO (AUTHORIZED OFFICIAL)
(305) 215-7452
Entity
Organization
Contact information
Practice address
3400 CORAL WAY STE 500, MIAMI, FL 33145-3053
(305) 603-8684
(833) 756-2656
Mailing address
3400 CORAL WAY STE 500, MIAMI, FL 33145-3053
(305) 603-8684
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
03/03/2022
Last updated
06/30/2026
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