Organization
MODERN UROLOGY, INC.
Active
Organization
MODERN UROLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERIK HOUTTUIN M.D. (PRESIDENT)
(636) 239-7559
Entity
Organization
Contact information
Practice address
1400 US HIGHWAY 61, SUITE 250, FESTUS, MO 63028-4100
(636) 239-7559
(636) 239-6947
Mailing address
1400 US HIGHWAY 61, SUITE 250, FESTUS, MO 63028-4100
(636) 239-7559
(636) 239-6947
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35745
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200000107
—
MO
05
—
505763607
—
MO
05
—
505763615
—
MO
Enumeration date
09/13/2006
Last updated
02/02/2009
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