Provider Demographics
NPI:1063592350
Name:WOUND SPECIALISTS OF MICHIGAN, P.L.L.C.
Entity type:Organization
Organization Name:WOUND SPECIALISTS OF MICHIGAN, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BONGIORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-645-5578
Mailing Address - Street 1:2900 GOLFSIDE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1410
Mailing Address - Country:US
Mailing Address - Phone:866-645-5578
Mailing Address - Fax:888-528-0919
Practice Address - Street 1:2900 GOLFSIDE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1410
Practice Address - Country:US
Practice Address - Phone:866-645-5578
Practice Address - Fax:888-528-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060835208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4281939Medicaid
0N17190Medicare PIN
0P17200Medicare PIN
MI4281939Medicaid
0N38410Medicare PIN