Provider Demographics
NPI:1356811483
Name:WYNWOOD HEALTHCARE, LLC
Entity type:Organization
Organization Name:WYNWOOD HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KURESHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-661-2333
Mailing Address - Street 1:7800 PRESTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3240
Mailing Address - Country:US
Mailing Address - Phone:469-661-2333
Mailing Address - Fax:469-442-0123
Practice Address - Street 1:7800 PRESTON RD STE 104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3240
Practice Address - Country:US
Practice Address - Phone:469-661-2333
Practice Address - Fax:469-442-0123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYNWOOD HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-02
Last Update Date:2018-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies