| Revive Wound Care Llc | |
|
2210 Midwest Rd Oak Brook IL 60523-1280 | |
| (630) 422-3943 | |
| Not Available |
| Full Name | Revive Wound Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2210 Midwest Rd, Oak Brook, Illinois |
| Authorized Official Name and Position | Luqman Baloch (PRESIDENT) |
| Authorized Official Contact | 6304223943 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Wound Care Llc 2210 Midwest Rd Oak Brook IL 60523-1280 Ph: () - | Revive Wound Care Llc 2210 Midwest Rd Oak Brook IL 60523-1280 Ph: (630) 422-3943 |
| NPI Number | 1942057955 |
|---|---|
| Provider Enumeration Date | 05/06/2024 |
| Last Update Date | 05/06/2024 |
| Medicare PECOS PAC ID | 3173065224 |
|---|---|
| Medicare Enrollment ID | O20240605001019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942057955 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Krish G Venoo |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1487829834 PECOS PAC ID: 1153227194 Enrollment ID: I20031210000335 |
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