NPIMap

Organization Active NPI

Midwest Wound Care Associates, PC

  • Surgery Physician
  • Dearborn, MI
National Provider Identifier
1477754604
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301046893 Issued in MI
Legal business name
MIDWEST WOUND CARE ASSOCIATES, PC
Practice address
22550 Law St
Dearborn, MI 48124-1087
Phone
(313) 228-4090
Fax
(313) 565-9827
NPI assigned
May 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carl T Bergren, M.D.
Title
President
Phone
(313) 228-4090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 4301046893 MI Primary

Addresses

Primary practice location

22550 Law St
Dearborn, MI 48124-1087

Mailing address

22550 Law St
Dearborn, MI 48124-1087
Phone (313) 228-4090

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477754604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22550 LAW ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241087",
            "telephone_number": "313-228-4090",
            "fax_number": "313-565-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22550 LAW ST",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241087",
            "telephone_number": "313-228-4090",
            "fax_number": "313-565-9827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST WOUND CARE ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGREN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-228-4090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301046893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.