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General NPI Number Information
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NPI Number | 1952469587
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Entity Type | Organization
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Legal Business Name | WOUND CARE CLINICS OF AMERICA, P.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 24111 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2841
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Country | US
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Telephone | 248-557-8800
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Fax | 248-557-8860
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Provider Business Mailing Address
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Address Line | 24111 SOUTHFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2841
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Country | US
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Telephone | 248-557-8800
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Fax | 248-557-8860
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTOR O UBOM
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Credential | DO
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Telephone | 248-557-8800
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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 | 4704127273
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704154666
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704170335
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704217515
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License Number State | MI
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