MEDICARE: NUVANTAGE WOUND CARE SOLUTIONS 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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1285100719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUVANTAGE WOUND CARE SOLUTIONS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3261
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48333-3261
Country	:	US
Telephone Number	:	313-520-1889
Fax Number	:

Provider Business Practice Location Address
First Line	:	21717 ROSE HOLLOW DR
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-5508
Country	:	US
Telephone Number	:	313-520-1889
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DELOREAN GRIFFIN
Credential	:	M.D.
Telephone Number	:	313-520-1889

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	10/23/2018

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