Healthcare Provider Details

I. General information

NPI: 1821899279
Provider Name (Legal Business Name): WOUND CARE ZONE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BROADWAY AVE NW APT 423
GRAND RAPIDS MI
49504-7324
US

IV. Provider business mailing address

600 BROADWAY AVE NW APT 423
GRAND RAPIDS MI
49504-7324
US

V. Phone/Fax

Practice location:
  • Phone: 616-606-0703
  • Fax: 616-552-8656
Mailing address:
  • Phone: 616-606-0703
  • Fax: 616-552-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ERIC KRECKMAN
Title or Position: PRESIDENT
Credential: PA
Phone: 989-492-0492