Provider Demographics
NPI:1144971482
Name:RESIDENTIAL PROFESSIONAL WOUND CARE SPECIALISTS PLLC
Entity type:Organization
Organization Name:RESIDENTIAL PROFESSIONAL WOUND CARE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIBHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-733-8286
Mailing Address - Street 1:3611 CARPENTER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2784
Mailing Address - Country:US
Mailing Address - Phone:313-733-8286
Mailing Address - Fax:313-826-0899
Practice Address - Street 1:20927 KELLY RD STE 1
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3128
Practice Address - Country:US
Practice Address - Phone:313-733-8286
Practice Address - Fax:313-826-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty