Provider Demographics
NPI:1972831410
Name:WOUND MANAGEMENT CONSULTANTS P.C.
Entity Type:Organization
Organization Name:WOUND MANAGEMENT CONSULTANTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-421-1586
Mailing Address - Street 1:1351 W CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-1853
Mailing Address - Country:US
Mailing Address - Phone:563-421-1586
Mailing Address - Fax:
Practice Address - Street 1:1351 W CENTRAL PARK AVE
Practice Address - Street 2:SUITE 1225
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-1853
Practice Address - Country:US
Practice Address - Phone:563-421-1586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA036071509207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty