Provider Demographics
NPI:1285100719
Name:NUVANTAGE WOUND CARE SOLUTIONS PLLC
Entity type:Organization
Organization Name:NUVANTAGE WOUND CARE SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DELOREAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-520-1889
Mailing Address - Street 1:PO BOX 3261
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-3261
Mailing Address - Country:US
Mailing Address - Phone:313-520-1889
Mailing Address - Fax:
Practice Address - Street 1:21717 ROSE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5508
Practice Address - Country:US
Practice Address - Phone:313-520-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty