Provider Demographics
NPI:1891525234
Name:ADVANCED FOOT AND WOUND CARE
Entity type:Organization
Organization Name:ADVANCED FOOT AND WOUND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-243-4530
Mailing Address - Street 1:601 KEISLER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6566
Mailing Address - Country:US
Mailing Address - Phone:919-249-5497
Mailing Address - Fax:800-901-4828
Practice Address - Street 1:601 KEISLER DR STE 100
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6566
Practice Address - Country:US
Practice Address - Phone:919-249-5497
Practice Address - Fax:800-901-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty