Organization
ASSOCIATED UROLOGICAL SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZA ROQUE (DIRECTOR)
(708) 608-2195
Entity
Organization
Contact information
Practice address
6701 159TH ST, TINLEY PARK, IL 60477-1758
(708) 915-7800
Mailing address
16255 S. 106 COURT, ORLAND PARK, IL 60467
(708) 590-8770
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
—
—
208800000X
Urology Physician
Primary
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Enumeration date
08/28/2007
Last updated
03/18/2020
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