Provider Demographics
NPI:1447821459
Name:ADVANCED WOUNDCARE, INC
Entity type:Organization
Organization Name:ADVANCED WOUNDCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAATOUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-730-7098
Mailing Address - Street 1:5250 OLD ORCHARD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-4462
Mailing Address - Country:US
Mailing Address - Phone:224-935-9522
Mailing Address - Fax:224-935-4399
Practice Address - Street 1:5250 OLD ORCHARD RD STE 300
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4462
Practice Address - Country:US
Practice Address - Phone:224-935-9522
Practice Address - Fax:224-935-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty