Healthcare Provider Details

I. General information

NPI: 1063385292
Provider Name (Legal Business Name): NEXGEN WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12288 PENINSULA DR
TRAVERSE CITY MI
49686-9245
US

IV. Provider business mailing address

12288 PENINSULA DR
TRAVERSE CITY MI
49686-9245
US

V. Phone/Fax

Practice location:
  • Phone: 231-649-2672
  • Fax:
Mailing address:
  • Phone: 231-649-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLIN SEGUIN
Title or Position: OWNER
Credential: DO
Phone: 231-649-2672