Provider Demographics
NPI:1881018794
Name:ADVANCED SKIN AND WOUND CARE LLC
Entity Type:Organization
Organization Name:ADVANCED SKIN AND WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FADI
Authorized Official - Middle Name:ELLIAS
Authorized Official - Last Name:SABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-322-1054
Mailing Address - Street 1:8830 BAYWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4605
Mailing Address - Country:US
Mailing Address - Phone:727-322-1054
Mailing Address - Fax:727-822-8081
Practice Address - Street 1:1839 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8900
Practice Address - Country:US
Practice Address - Phone:727-322-1054
Practice Address - Fax:727-822-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty