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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