Provider Demographics
NPI:1952469587
Name:WOUND CARE CLINICS OF AMERICA, P.C.
Entity Type:Organization
Organization Name:WOUND CARE CLINICS OF AMERICA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:O
Authorized Official - Last Name:UBOM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-557-8800
Mailing Address - Street 1:24111 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2841
Mailing Address - Country:US
Mailing Address - Phone:248-557-8800
Mailing Address - Fax:248-557-8860
Practice Address - Street 1:24111 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2841
Practice Address - Country:US
Practice Address - Phone:248-557-8800
Practice Address - Fax:248-557-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217515363L00000X
MI4704127273363L00000X
MI4704154666363L00000X
MI4704170335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4661061-11Medicaid
MI4737894-11Medicaid
MI4868706-11Medicaid
MI500F324120OtherBCBSM
MI4661052-11Medicaid
MI500F324120OtherBCBSM