Provider Demographics
NPI:1467726935
Name:MIDWEST WOUND CARE,LLC
Entity Type:Organization
Organization Name:MIDWEST WOUND CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-350-0515
Mailing Address - Street 1:19401 E US HIGHWAY 40
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5451
Mailing Address - Country:US
Mailing Address - Phone:816-350-0515
Mailing Address - Fax:
Practice Address - Street 1:19401 E US HIGHWAY 40
Practice Address - Street 2:SUITE 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5451
Practice Address - Country:US
Practice Address - Phone:816-350-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty