Provider Demographics
NPI:1366898108
Name:ADVANCED UROLOGY INSTITUTE
Entity type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRABLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-205-8981
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3398
Mailing Address - Country:US
Mailing Address - Phone:727-441-1508
Mailing Address - Fax:
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3398
Practice Address - Country:US
Practice Address - Phone:727-441-1508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site