MEDICARE: WOUND CARE SPECIALIST 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1285313155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOUND CARE SPECIALIST INC

Provider Business Mailing Address
First Line	:	4001 W DEVON AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4537
Country	:	US
Telephone Number	:	773-887-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W DEVON AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-4537
Country	:	US
Telephone Number	:	773-887-6900
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	RAYEESA FARHATH
Credential	:
Telephone Number	:	773-887-6900

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	10/10/2024

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Directions to “WOUND CARE SPECIALIST INC ” Practice Location

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