Organization
BLUE WATER RAD ONC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CATHEY (BILLING/CREDENTIALING)
(810) 216-1833
Entity
Organization
Contact information
Practice address
2601 ELECTRIC AVE, PORT HURON, MI 48060-6587
(810) 216-2902
(810) 216-3025
Mailing address
2601 ELECTRIC AVE, PORT HURON, MI 48060-6587
(810) 216-2902
(810) 216-3025
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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