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General NPI Number Information
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NPI Number | 1104665843
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Entity Type | Organization
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Legal Business Name | LEGENDS WOUND CARE LLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 8130 MCCORMICK BLVD
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City | SKOKIE
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State | IL
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Zip | 60076-2920
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Country | US
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Telephone | 999-999-9999
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Fax | 847-500-9444
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Provider Business Mailing Address
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Address Line | 8130 MCCORMICK BLVD
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City | SKOKIE
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State | IL
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Zip | 60076-2920
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MORRIS FRIEDMAN
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Credential | DO
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Telephone | 847-500-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | NULL
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