Healthcare Provider Details

I. General information

NPI: 1467096065
Provider Name (Legal Business Name): WOUND CARE PHYSICIANS OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E WILLETTA ST
PHOENIX AZ
85006-2749
US

IV. Provider business mailing address

19411 E REINS RD
QUEEN CREEK AZ
85142-8628
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-6040
  • Fax:
Mailing address:
  • Phone: 972-951-9691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: TROY WILDE
Title or Position: PODIATRIST
Credential: DPM
Phone: 972-951-9691