MEDICARE: EVOCARE WOUND SOLUTIONS PA

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1922827872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOCARE WOUND SOLUTIONS PA

Provider Business Mailing Address
First Line	:	400 N MAY ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-6495
Country	:	US
Telephone Number	:	800-766-0666
Fax Number	:	800-297-0666

Provider Business Practice Location Address
First Line	:	400 N MAY ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-6495
Country	:	US
Telephone Number	:	800-766-0666
Fax Number	:	800-297-0666

Authorized Official
Title or Position	:	OWNER
Name	:	DOMINIC GAZIANO
Credential	:	MD
Telephone Number	:	800-766-0666

Provider Enumeration Date	:	10/08/2024
Last Update Date	:	11/12/2024

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Directions to “EVOCARE WOUND SOLUTIONS PA ” Practice Location

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