| NPI | 1043486731 |
|---|---|
| Doing Business As | LAKE SHORE UROLOGY AT ST. MARY'S |
| Entity Type | Organization |
| Authorized Contact | MARK D EVARD VP Of Revenue Cycle 217-492-9651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2023-09-19 |