Provider Demographics
NPI:1083357305
Name:OHIO WOUND CARE DOCS
Entity Type:Organization
Organization Name:OHIO WOUND CARE DOCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AYODELE
Authorized Official - Last Name:OTIKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-708-7668
Mailing Address - Street 1:4640 ADMIRALTY WAY STE 500
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6636
Mailing Address - Country:US
Mailing Address - Phone:323-434-9441
Mailing Address - Fax:323-433-9177
Practice Address - Street 1:6789 RIDGE RD STE 305
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5635
Practice Address - Country:US
Practice Address - Phone:323-434-9441
Practice Address - Fax:323-433-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty