Organization
AVANTI WOUND PHYSICIANS, PLLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICK RIVAS MD (OWNER)
(630) 686-2134
Entity
Organization
Contact information
Practice address
2222 W GRAND RIVER AVE STE A, OKEMOS, MI 48864-1604
(630) 686-2134
Mailing address
4 E OGDEN AVE STE 348, WESTMONT, IL 60559-3506
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
208600000X
Surgery Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
03/06/2018
Last updated
02/28/2022
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