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General NPI Number Information
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NPI Number | 1063919934
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND CARE SOLUTIONS LLC
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 10101 W WISCONSIN AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-4861
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Country | US
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Telephone | 314-560-7057
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S BEDFORD ST STE 1
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City | MADISON
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State | WI
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Zip | 53703-3691
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Country | US
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Telephone | 314-560-7057
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Fax |
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | DR. RADHAKRISHNA JANARDHAN
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Credential | MD
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Telephone | 314-560-7057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 56746-20
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License Number State | WI
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