Organization
NORTH UROLOGY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND ALLEN HACKETT M.D. (PRESIDENT)
(763) 520-5888
Entity
Organization
Contact information
Practice address
4080 W BROADWAY AVE, SUITE #310, ROBBINSDALE, MN 55422-5604
(763) 520-5888
(763) 520-5955
Mailing address
4080 W BROADWAY AVE, SUITE #310, ROBBINSDALE, MN 55422-5604
(763) 520-5888
(763) 520-5955
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
040181
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001
MEDICA CHOICE
—
01
—
101378
UCARE
—
01
—
18063TW
BLUE CROSS BLUE SHIELD
—
05
—
248645800
—
MN
05
—
32722000
—
WI
01
—
339
HEALTHPARTNERS
—
01
—
CP8671
RAILROAD MEDICARE
MN
Enumeration date
03/21/2007
Last updated
11/14/2008
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