MEDICARE: HEALTECH ADVANCED WOUND CARE

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1932915840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTECH ADVANCED WOUND CARE

Provider Business Mailing Address
First Line	:	15002 LAKEFAIR DR STE 105
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-3995
Country	:	US
Telephone Number	:	346-837-9881
Fax Number	:

Provider Business Practice Location Address
First Line	:	15002 LAKEFAIR DR STE 105
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-3995
Country	:	US
Telephone Number	:	346-837-9881
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADEBOLA ADEFUYE
Credential	:
Telephone Number	:	346-837-9881

Provider Enumeration Date	:	12/05/2024
Last Update Date	:	12/05/2024

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Directions to “HEALTECH ADVANCED WOUND CARE ” Practice Location

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