MEDICARE: WOUND CARE MEDICAL OHIO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1174486807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE MEDICAL OHIO LLC

Provider Business Mailing Address
First Line	:	701 S CAPITAL OF TEXAS HWY STE D420
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5986
Country	:	US
Telephone Number	:	737-703-8191
Fax Number	:	512-243-6916

Provider Business Practice Location Address
First Line	:	6545 MARKET AVE N STE 100
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	737-703-8191
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL SEESTADT
Credential	:
Telephone Number	:	737-703-8191

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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