Healthcare Provider Details

I. General information

NPI: 1144769100
Provider Name (Legal Business Name): PRECISION WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 W GREENLEAF AVE
CHICAGO IL
60645-2913
US

IV. Provider business mailing address

2833 W GREENLEAF AVE
CHICAGO IL
60645-2913
US

V. Phone/Fax

Practice location:
  • Phone: 773-543-6479
  • Fax:
Mailing address:
  • Phone: 773-543-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH GOLDMAN
Title or Position: MEMBER
Credential:
Phone: 773-543-6479