Provider Demographics
NPI:1467096065
Name:WOUND CARE PHYSICIANS OF ARIZONA PLLC
Entity Type:Organization
Organization Name:WOUND CARE PHYSICIANS OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-951-9691
Mailing Address - Street 1:19411 E REINS RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-8628
Mailing Address - Country:US
Mailing Address - Phone:972-951-9691
Mailing Address - Fax:
Practice Address - Street 1:1012 E WILLETTA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2749
Practice Address - Country:US
Practice Address - Phone:602-839-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty