Healthcare Provider Details

I. General information

NPI: 1285100719
Provider Name (Legal Business Name): NUVANTAGE WOUND CARE SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21717 ROSE HOLLOW DR
SOUTHFIELD MI
48075-5508
US

IV. Provider business mailing address

PO BOX 3261
FARMINGTON HILLS MI
48333-3261
US

V. Phone/Fax

Practice location:
  • Phone: 313-520-1889
  • Fax:
Mailing address:
  • Phone: 313-520-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DELOREAN GRIFFIN
Title or Position: CEO
Credential: M.D.
Phone: 313-520-1889