Provider Demographics
NPI:1700666708
Name:ADVANCED WOUND CARE OF CARO PC
Entity Type:Organization
Organization Name:ADVANCED WOUND CARE OF CARO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-894-7024
Mailing Address - Street 1:1800 W CARO RD
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-8209
Mailing Address - Country:US
Mailing Address - Phone:488-947-0242
Mailing Address - Fax:855-552-3776
Practice Address - Street 1:1800 W CARO RD STE 12
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-8209
Practice Address - Country:US
Practice Address - Phone:727-800-9958
Practice Address - Fax:855-552-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty