Provider Demographics
NPI:1245410851
Name:PREMIER WOUND SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PREMIER WOUND SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIEZGODA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-524-2784
Mailing Address - Street 1:9875 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8895
Mailing Address - Country:US
Mailing Address - Phone:414-858-2200
Mailing Address - Fax:414-858-2230
Practice Address - Street 1:2400 GOLF RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5590
Practice Address - Country:US
Practice Address - Phone:262-524-2784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty