# IDIA WOUND & PAIN CARE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114880853
- **Authorized official:** NICHOLAS EFOSA AGBONIFO (ADMINISTRATOR)
- **Authorized official phone:** (773) 240-9225

## Contact information

- **Practice address:** 3525 W PETERSON AVE, STE 505, CHICAGO, IL 60659
- **Practice address phone:** (773) 240-9225
- **Mailing address:** 980 N MICHIGAN AVE STE 1090, CHICAGO, IL 60611-4521
- **Mailing address phone:** (773) 240-9225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2025
- **Last updated:** 12/09/2025