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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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