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General NPI Number Information
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NPI Number | 1730322736
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND CARE & PLASTIC SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 902 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-3220
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Country | US
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Telephone | 316-425-5016
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Fax | 316-425-0422
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Provider Business Mailing Address
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Address Line | 902 N HILLSIDE ST
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City | WICHITA
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State | KS
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Zip | 67214-3220
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Country | US
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Telephone | 316-425-5016
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Fax | 316-425-0422
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. JEREMY TAMIR
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Credential | MD, FAPWCA
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Telephone | 316-201-8573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-32928
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License Number State | KS
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