Organization
TAWAS FOOT CLINIC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN R WRIGHT (BUSINESS MANAGER)
(989) 362-6558
Entity
Organization
Contact information
Practice address
166 M 55, TAWAS CITY, MI 48763
(989) 362-6558
(989) 362-7168
Mailing address
PO BOX 178, TAWAS CITY, MI 48764-0178
(989) 362-6558
(989) 365-7168
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
5901001133
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4310389
—
MI
01
—
480026004
PALMETTO GBA-RR MEDICARE
MI
01
—
71020000C51005
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/23/2006
Last updated
02/19/2014
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