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
10400 SOUTHWEST HWY, CHICAGO RIDGE, IL 60415-1367
(708) 581-7308
(708) 274-4027
Mailing address
16522 106TH CT, ORLAND PARK, IL 60467-4547
(708) 590-8770
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
036-076990
IL
208800000X
Urology Physician
036-094573
IL
208800000X
Urology Physician
036-096031
IL
208800000X
Urology Physician
036-102534
IL
208800000X
Urology Physician
Primary
036-120732
IL
208800000X
Urology Physician
036-257763
IL
2088P0231X
Pediatric Urology Physician
036-062338
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232706
BCBS
IL
Enumeration date
02/10/2009
Last updated
03/18/2020
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