Provider Demographics
NPI:1922511898
Name:WOUND CARE & RESEARCH CENTER OF NORTH TEXAS PLLC
Entity Type:Organization
Organization Name:WOUND CARE & RESEARCH CENTER OF NORTH TEXAS PLLC
Other - Org Name:LEWISVILLE WOUND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JALIL
Authorized Official - Middle Name:AZIZ
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-316-0902
Mailing Address - Street 1:502 N VALLEY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-316-0902
Mailing Address - Fax:972-316-1161
Practice Address - Street 1:502 N VALLEY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-316-0902
Practice Address - Fax:972-316-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9128207R00000X
2083P0011X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty