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General NPI Number Information
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NPI Number | 1922827872
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Entity Type | Organization
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Legal Business Name | EVOCARE WOUND SOLUTIONS PA
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 400 N MAY ST STE 101
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City | CHICAGO
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State | IL
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Zip | 60642-6495
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Country | US
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Telephone | 800-766-0666
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Fax | 800-297-0666
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Provider Business Mailing Address
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Address Line | 400 N MAY ST STE 101
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City | CHICAGO
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State | IL
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Zip | 60642-6495
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Country | US
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Telephone | 800-766-0666
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Fax | 800-297-0666
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Authorized Official
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Title or Position | OWNER
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Name | DOMINIC GAZIANO
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Credential | MD
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Telephone | 800-766-0666
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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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