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Organization
BLUE WATER PODIATRY PC
Active
Organization
BLUE WATER PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS ERNST DPM (OWNER)
(989) 269-9575
Entity
Organization
Contact information
Practice address
1060 S VAN DYKE RD, SUITE 100, BAD AXE, MI 48413-9631
(989) 269-9575
(989) 269-9576
Mailing address
5303 SHOREWOOD DR, FORT GRATIOT, MI 48059-3137
(810) 385-2053
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
59000955
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1958354
—
MI
Enumeration date
01/31/2007
Last updated
01/20/2010
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