Organization
PROMEDICA GENITO-URINARY SURGEONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY L DWYER (CREDENTIALING SUPERVISOR)
(419) 824-7334
Entity
Organization
Contact information
Practice address
605 3RD AVE STE A, SUITE B, FREMONT, OH 43420-3269
(419) 332-7221
(419) 332-7225
Mailing address
605 3RD AVE STE A, SUITE B, FREMONT, OH 43420-3269
(419) 332-7221
(419) 332-7225
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
OH
Other
Enumeration date
10/02/2013
Last updated
10/02/2013
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