| Midwest Wound Care | |
|
1190 Lily Cache Ln Apt 103 Bolingbrook IL 60490-3284 | |
| (630) 731-4492 | |
| Not Available |
| Full Name | Midwest Wound Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 1190 Lily Cache Ln Apt 103, Bolingbrook, Illinois |
| Authorized Official Name and Position | Ruth Odamtten (PRESIDENT) |
| Authorized Official Contact | 6307314492 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Wound Care 1190 Lily Cache Ln Apt 103 Bolingbrook IL 60490-3284 Ph: (630) 731-4492 | Midwest Wound Care 1190 Lily Cache Ln Apt 103 Bolingbrook IL 60490-3284 Ph: (630) 731-4492 |
| NPI Number | 1538976873 |
|---|---|
| Provider Enumeration Date | 12/11/2024 |
| Last Update Date | 12/11/2024 |
| Medicare PECOS PAC ID | 3173052719 |
|---|---|
| Medicare Enrollment ID | O20250127000427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538976873 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Taryrsha Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821552761 PECOS PAC ID: 7911246368 Enrollment ID: I20190228002263 |
| Provider Name | Monica Medrano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821655663 PECOS PAC ID: 4082949433 Enrollment ID: I20220721002687 |
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