Provider Demographics
NPI:1962601393
Name:WOUND TECHNOLOGY NETWORK INC
Entity type:Organization
Organization Name:WOUND TECHNOLOGY NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MINGHSUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-923-7440
Mailing Address - Street 1:200 S PARK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8541
Mailing Address - Country:US
Mailing Address - Phone:954-923-7440
Mailing Address - Fax:954-923-1299
Practice Address - Street 1:200 S PARK RD STE 200
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8541
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:954-923-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0049450213E00000X
207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE54349Medicare UPIN