Provider Demographics
NPI:1316254113
Name:COMPREHENSIVE WOUND CARE, LLC.
Entity type:Organization
Organization Name:COMPREHENSIVE WOUND CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DD
Authorized Official - Phone:847-559-7702
Mailing Address - Street 1:874 BOAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1308
Mailing Address - Country:US
Mailing Address - Phone:847-784-8955
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD STE 406
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1453
Practice Address - Country:US
Practice Address - Phone:478-559-7702
Practice Address - Fax:847-563-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.102521208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty