| Integrated Wound Care Illinois Pllc | |
|
801 Adlai Stevenson Dr Springfield IL 62703-4261 | |
| (718) 963-3495 | |
| Not Available |
| Full Name | Integrated Wound Care Illinois Pllc |
|---|---|
| Speciality | General Practice |
| Location | 801 Adlai Stevenson Dr, Springfield, Illinois |
| Authorized Official Name and Position | Diane Lusas (PRESIDENT) |
| Authorized Official Contact | 7189633495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Wound Care Illinois Pllc 492c Cedar Ln Ste 514 Teaneck NJ 07666-1713 Ph: (718) 963-3495 | Integrated Wound Care Illinois Pllc 801 Adlai Stevenson Dr Springfield IL 62703-4261 Ph: (718) 963-3495 |
| NPI Number | 1700539780 |
|---|---|
| Provider Enumeration Date | 01/31/2022 |
| Last Update Date | 01/31/2022 |
| Medicare PECOS PAC ID | 4688068943 |
|---|---|
| Medicare Enrollment ID | O20220302001614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700539780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Amrinder Kaur Mangat |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285214999 PECOS PAC ID: 9537578695 Enrollment ID: I20210503001369 |
| Provider Name | Diane Lusas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1730475658 PECOS PAC ID: 9032430640 Enrollment ID: I20220302001939 |
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