Provider Demographics
NPI:1730376955
Name:MONROE UROLOGY ASSOCIATES PLLC
Entity type:Organization
Organization Name:MONROE UROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMACHANDRAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-243-9620
Mailing Address - Street 1:PO BOX 2165
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-7165
Mailing Address - Country:US
Mailing Address - Phone:734-243-9620
Mailing Address - Fax:734-243-3565
Practice Address - Street 1:905 N MACOMB ST
Practice Address - Street 2:SUITE #5
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3075
Practice Address - Country:US
Practice Address - Phone:734-243-9620
Practice Address - Fax:734-243-3565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4387651Medicaid
MI0N44860Medicare UPIN