Provider Demographics
NPI:1891534939
Name:IVPS WOUND CARE PLLC
Entity type:Organization
Organization Name:IVPS WOUND CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-497-8721
Mailing Address - Street 1:18000 W 9 MILE RD STE 525
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4080
Mailing Address - Country:US
Mailing Address - Phone:248-327-6196
Mailing Address - Fax:
Practice Address - Street 1:18000 W 9 MILE RD STE 525
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4080
Practice Address - Country:US
Practice Address - Phone:248-327-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty