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
Update your record
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