Organization
PRIME UROLOGY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNERSTO TAN M.D. (PRESIDENT)
(815) 741-1020
Entity
Organization
Contact information
Practice address
300 READ ST, STE A, LOCKPORT, IL 60441-3265
(815) 741-1020
(815) 221-4175
Mailing address
300 READ ST, STE A, LOCKPORT, IL 60441-3265
(815) 741-1020
(815) 221-4175
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
036049705
IL
Other
Enumeration date
03/29/2017
Last updated
03/29/2017
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