Provider Demographics
NPI:1063784379
Name:WOUND CARE SPECIALISTS OF AMERICA CHARTERED
Entity type:Organization
Organization Name:WOUND CARE SPECIALISTS OF AMERICA CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-564-5444
Mailing Address - Street 1:8222 S KING DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4964
Mailing Address - Country:US
Mailing Address - Phone:312-222-0030
Mailing Address - Fax:773-873-4060
Practice Address - Street 1:8222 S KING DR
Practice Address - Street 2:SUITE F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-4964
Practice Address - Country:US
Practice Address - Phone:312-222-0030
Practice Address - Fax:773-873-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty