Provider Demographics
NPI:1013755909
Name:WOUND KINETICS L L C
Entity type:Organization
Organization Name:WOUND KINETICS L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IEDEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-359-2528
Mailing Address - Street 1:4485 SILAS DR
Mailing Address - Street 2:
Mailing Address - City:DORR
Mailing Address - State:MI
Mailing Address - Zip Code:49323-8003
Mailing Address - Country:US
Mailing Address - Phone:616-359-2529
Mailing Address - Fax:
Practice Address - Street 1:1240 WESTLAWN DR
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-4657
Practice Address - Country:US
Practice Address - Phone:616-359-2528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty