Organization
CENTRAL MISSOURI UROLOGY CLINIC, INC
Active
Organization
CENTRAL MISSOURI UROLOGY CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY THOMAS KACZMAREK M.D. (PRESIDENT UROLOGIST)
(573) 364-1014
Entity
Organization
Contact information
Practice address
1428 EAST 72 HIGHWAY, ROLLA, MO 65401
(573) 364-1014
(573) 364-6872
Mailing address
1428 EAST STATE ROUTE 72, ROLLA, MO 65401
(573) 364-1014
(573) 364-6872
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
110031
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208305102
—
MO
Enumeration date
04/11/2006
Last updated
06/29/2010
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