Provider Demographics
NPI:1336946854
Name:ADVANCE WOUND CARE LLC
Entity type:Organization
Organization Name:ADVANCE WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POOPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHTIARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-555-4154
Mailing Address - Street 1:4649 PONCE DE LEON BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4649 PONCE DE LEON BLVD STE 406
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2121
Practice Address - Country:US
Practice Address - Phone:717-345-7415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty