Organization
IDIA WOUND & PAIN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS EFOSA AGBONIFO (ADMINISTRATOR)
(773) 240-9225
Entity
Organization
Contact information
Practice address
3525 W PETERSON AVE, STE 505, CHICAGO, IL 60659
(773) 240-9225
Mailing address
980 N MICHIGAN AVE STE 1090, CHICAGO, IL 60611-4521
(773) 240-9225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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