10D2165243 CLIA NUMBER - ADVANCED UROLOGY INSTITUTE LLC

Laboratory Demographics

CLIA Number: 10D2165243

Facility Name: ADVANCED UROLOGY INSTITUTE LLC

Facility Address:
6811 PALISADES COURT PARK SUITES 1-4
FORT MYERS, FL
ZIP 33912
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Facility Phone Number: 352 430-2937

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1649293523

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	10D2165243
LAB Type	Physician Office
Facility Name	ADVANCED UROLOGY INSTITUTE LLC
Street	6811 PALISADES COURT PARK SUITES 1-4
City	FORT MYERS
State	FL
ZIP	33912
Phone	352 430-2937
CertificateType	4
CertificateEffectiveDate	4/23/2023
CertificateExpirationDate	4/22/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024