Individual
DR. THOMAS BRUCE DE KORTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1404 BRIDGE ST, CHARLEVOIX, MI 49720-2603
(231) 547-4662
(231) 547-3068
Mailing address
PO BOX 103, 1404 BRIDGE STREET, CHARLEVOIX, MI 49720-0103
(231) 547-4662
(231) 547-3068
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
TD001078
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1441583
—
MI
01
—
5155000
BLUE CROSS
MI
Enumeration date
10/17/2006
Last updated
11/28/2007
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