Organization
BLUE WATER PODIATRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS K ERNST DPM (OWNER)
(810) 982-4240
Entity
Organization
Contact information
Practice address
828 10TH AVE, PORT HURON, MI 48060-3640
(810) 982-4240
(810) 982-2479
Mailing address
5303 SHOREWOOD DR, FORT GRATIOT, MI 48059-3137
(810) 385-2053
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
59000955
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1958336
—
MI
Enumeration date
01/31/2007
Last updated
10/19/2007
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