Organization
FANTASTIC WOUND CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLAYEMI OLAJIDE OSLYEMI M.D (PRESIDENT)
(561) 602-9988
Entity
Organization
Contact information
Practice address
2580 METROCENTRE BOULEVARD, SUITE 5, WEST PALM BEACH, FL 33407
(561) 602-9988
Mailing address
2580 METROCENTRE BOULEVARD, SUITE 5, WEST PALM BEACH, FL 33407
(561) 602-9988
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
163WX1500X
Ostomy Care Registered Nurse
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Enumeration date
04/17/2018
Last updated
04/17/2018
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