MEDICARE: DYNAMIC WOUND CARE 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1316810450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC WOUND CARE LLC

Provider Business Mailing Address
First Line	:	9550 S EASTERN AVE STE 248
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8041
Country	:	US
Telephone Number	:	305-901-5055
Fax Number	:

Provider Business Practice Location Address
First Line	:	9550 S EASTERN AVE STE 248
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8041
Country	:	US
Telephone Number	:	305-901-5055
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	KIRILL FILATOV
Credential	:
Telephone Number	:	305-901-5055

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	09/25/2025

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Directions to “DYNAMIC WOUND CARE LLC ” Practice Location

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