Provider Demographics
NPI:1922827872
Name:EVOCARE WOUND SOLUTIONS PA
Entity type:Organization
Organization Name:EVOCARE WOUND SOLUTIONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-766-0666
Mailing Address - Street 1:400 N MAY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6495
Mailing Address - Country:US
Mailing Address - Phone:800-766-0666
Mailing Address - Fax:800-297-0666
Practice Address - Street 1:400 N MAY ST STE 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-6495
Practice Address - Country:US
Practice Address - Phone:800-766-0666
Practice Address - Fax:800-297-0666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty