Organization
BLUE WATER THORACIC AND CARDIOVASCULAR SURGERY, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VERNON DENCKLAU DO (OWNER)
(810) 989-6113
Entity
Organization
Contact information
Practice address
1107 STONE ST, SUITE 1, PORT HURON, MI 48060-3569
(810) 989-6113
(810) 989-6117
Mailing address
1107 STONE ST, SUITE 1, PORT HURON, MI 48060-3569
(810) 989-6113
(810) 989-6117
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
5101007542
MI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
5101007542
MI
Other
Enumeration date
12/11/2007
Last updated
08/11/2008
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