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General NPI Number Information
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NPI Number | 1578376869
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Entity Type | Organization
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Legal Business Name | REGEN WOUND & WELLNESS
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 2675 LITTLE YORK RD
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City | DAYTON
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State | OH
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Zip | 45414-1631
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Country | US
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Telephone | 937-626-4558
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Fax |
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Provider Business Mailing Address
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Address Line | 2675 LITTLE YORK RD
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City | DAYTON
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State | OH
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Zip | 45414-1631
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Country | US
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Telephone | 937-626-4558
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MATTHEW ELAM
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Credential |
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Telephone | 937-626-4558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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