Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mendo Lake Urologic Medical Group, Inc

Organization Specialist · NPI 1083646525

Mendo Lake Urologic Medical Group, Inc is a Specialist in Ukiah, California. Licensed in California. Registered with an NPI since 2006.

Licensed in
CA
In the registry since
2006
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

246 Hospital Dr
Ukiah, CA 95482-4533
Phone: (707) 462-1928
Fax: (707) 462-8642
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence A24853 (CA)

Record details

NPI number1083646525
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Robert Blackwelder — Owner · (707) 462-1928
Other names Mendo Lake Urology
NPI enumeratedJuly 7, 2006
Last updated in NPPESJuly 18, 2007
Mailing address246 Hospital Dr, Ukiah, CA 95482-4533

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