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Organization

WOLVERINE ORTHOTICS, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ERNST WALTER BASTIAN CO (PRESIDENT)
(248) 324-3010
Entity
Organization

Contact information

Practice address
28455 HAGGERTY RD, 101, NOVI, MI 48377-2982
(248) 324-3010
(248) 324-3003
Mailing address
28455 HAGGERTY RD, 101, NOVI, MI 48377-2982
(248) 324-3010
(248) 324-3003

Taxonomy

Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
510F312100
BCBSM
MI
05
853203750
MI
Enumeration date
07/21/2006
Last updated
12/20/2010
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