Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Mendo Lake Urologic Medical Group, Inc

Organization Specialist · NPI 1083646525

Mendo Lake Urologic Medical Group, Inc provides Specialist services 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 Not confirmed with CMS for 19 years — call before visiting
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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