Provider Demographics
NPI:1275341422
Name:RESTORE MEDICAL & WOUND EXPERTS
Entity type:Organization
Organization Name:RESTORE MEDICAL & WOUND EXPERTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIONES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:623-265-3786
Mailing Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9525
Mailing Address - Country:US
Mailing Address - Phone:623-265-3786
Mailing Address - Fax:
Practice Address - Street 1:12725 W INDIAN SCHOOL RD STE E101
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9525
Practice Address - Country:US
Practice Address - Phone:623-265-3786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice