Provider Demographics
NPI:1538298690
Name:MACOMB CLINTON CENTER FOR WOUND CARE AND HYPERBARIC MEDICINE. PLLC
Entity Type:Organization
Organization Name:MACOMB CLINTON CENTER FOR WOUND CARE AND HYPERBARIC MEDICINE. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:V
Authorized Official - Last Name:UTARNACHITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-228-7308
Mailing Address - Street 1:43475 DALCOMA DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3591
Mailing Address - Country:US
Mailing Address - Phone:586-228-7308
Mailing Address - Fax:
Practice Address - Street 1:43475 DALCOMA DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-3591
Practice Address - Country:US
Practice Address - Phone:586-228-7308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P01560Medicare ID - Type Unspecified