Organization
INTEGRATED WOUND CARE MANAGEMENT WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE LUSAS MD (MEMBER)
(732) 451-4318
Entity
Organization
Contact information
Practice address
1800 NEW YORK AVE, SUPERIOR, WI 54880-2008
(201) 870-1194
Mailing address
492C CEDAR LN STE 513, TEANECK, NJ 07666-1713
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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