MEDICARE: WOUNDOC INC

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	208600000X	Surgery Physician		IL

General Provider Information

NPI Number	:	1164412334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUNDOC INC

Provider Business Mailing Address
First Line	:	2115 N WINCHESTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3914
Country	:	US
Telephone Number	:	773-772-9830
Fax Number	:	312-602-5675

Provider Business Practice Location Address
First Line	:	2115 N WINCHESTER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3914
Country	:	US
Telephone Number	:	773-772-9830
Fax Number	:	312-602-5675

Authorized Official
Title or Position	:	ADMINISTRATIVE OFFICER
Name	:	MR. DAVID A SULLIVAN
Credential	:
Telephone Number	:	773-772-9380

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	08/22/2020

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Directions to “WOUNDOC INC ” Practice Location

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