Provider Demographics
NPI:1295621209
Name:COMPREHENSIVE WOUND CARE CENTER OF MICHIGAN PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE WOUND CARE CENTER OF MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LODER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-329-3895
Mailing Address - Street 1:15760 19 MILE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6319
Mailing Address - Country:US
Mailing Address - Phone:586-329-3895
Mailing Address - Fax:586-698-1574
Practice Address - Street 1:15760 19 MILE RD STE A
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6319
Practice Address - Country:US
Practice Address - Phone:586-329-3895
Practice Address - Fax:586-698-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty