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General NPI Number Information
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NPI Number | 1457830804
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Entity Type | Organization
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Legal Business Name | FANTASTIC WOUND CARE INC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 2580 METROCENTRE BLVD STE 6
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3100
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Country | US
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Telephone | 561-602-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 2580 METROCENTRE BLVD STE 6
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3100
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Country | US
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Telephone | 561-725-4100
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PART OWNER
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Name | DR. OLAYEMI OSIYEMI
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Credential | MD
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Telephone | 561-725-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | FL
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