MEDICARE: WOUND CARE CONSULTANTS OF PENNSYLVANIA, LLC

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

General Provider Information

NPI Number	:	1255068912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE CONSULTANTS OF PENNSYLVANIA, LLC

Provider Business Mailing Address
First Line	:	23250 CHAGRIN BLVD STE 150
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5417
Country	:	US
Telephone Number	:	216-402-0027
Fax Number	:	330-574-1050

Provider Business Practice Location Address
First Line	:	1755 US ROUTE 6 W
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-1025
Country	:	US
Telephone Number	:	216-402-0027
Fax Number	:	330-574-1050

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. SEBASTIAN CRUZ-SCHIAVONE
Credential	:	MD
Telephone Number	:	216-402-0027

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/03/2022

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