MEDICARE: UNITED WOUNDCARE INSTITUTE NC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician

General Provider Information

NPI Number	:	1043036049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED WOUNDCARE INSTITUTE NC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 809208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-9201
Country	:	US
Telephone Number	:	248-607-0037
Fax Number	:	734-462-0344

Provider Business Practice Location Address
First Line	:	4037 E INDEPENDENCE BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-3260
Country	:	US
Telephone Number	:	888-402-0202
Fax Number	:	888-860-2960

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE
Name	:	KIMBERLY MILLER
Credential	:
Telephone Number	:	248-331-7908

Provider Enumeration Date	:	11/25/2024
Last Update Date	:	03/11/2026

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