Organization
WESTERN UROLOGICAL ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT S NICKOLISEN MD (OWNER)
(602) 377-5900
Entity
Organization
Contact information
Practice address
601 W RIVERSIDE DR, SUITES 3 AND 4, PARKER, AZ 85344-5119
(602) 377-5900
Mailing address
2485 STROKE DR, LAKE HAVASU CITY, AZ 86406-7622
(602) 377-5900
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
15301
AZ
Other
Enumeration date
12/05/2007
Last updated
10/27/2010
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