Organization
IMPLEXUS WOUND CARE SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD ALAN WOLLHEIM MD WCC (MANAGING MEMBER)
(920) 261-4069
Entity
Organization
Contact information
Practice address
1911 GATEWAY DRIVE, WATERTOWN, WI 53094
(920) 261-4069
Mailing address
1911 GATEWAY DRIVE, WATERTOWN, WI 53094
(920) 261-4069
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20951020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023435
ENTITY ID NUMBER FOR ARTI
WI
Enumeration date
11/21/2006
Last updated
08/22/2020
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