Healthcare Provider Details

I. General information

NPI: 1346549409
Provider Name (Legal Business Name): MICHIGAN WOUND CARE AND HYPERBARIC INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24111 SOUTHFIELD RD
SOUTHFIELD MI
48075-2841
US

IV. Provider business mailing address

24111 SOUTHFIELD RD
SOUTHFIELD MI
48075-2841
US

V. Phone/Fax

Practice location:
  • Phone: 248-557-8800
  • Fax: 248-557-8860
Mailing address:
  • Phone: 248-557-8800
  • Fax: 248-557-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5101007418
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704217515
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704154415
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704248242
License Number StateMI

VIII. Authorized Official

Name: DR. VICTOR O UBOM
Title or Position: OWNER
Credential: D.O.
Phone: 248-557-8800