Healthcare Provider Details

I. General information

NPI: 1932082203
Provider Name (Legal Business Name): ADVANCED WOUND CARE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W CARO RD
CARO MI
48723-8209
US

IV. Provider business mailing address

1800 W CARO RD
CARO MI
48723-8209
US

V. Phone/Fax

Practice location:
  • Phone: 989-625-8399
  • Fax:
Mailing address:
  • Phone: 989-625-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TYLER STOUT
Title or Position: DIRECTOR
Credential:
Phone: 337-315-7927