Organization
PORT HURON BONE AND JOINT SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT D TRAVIS MD (OWNER)
(734) 451-9692
Entity
Organization
Contact information
Practice address
1985 GRATIOT BLVD, MARYSVILLE, MI 48040-2215
(734) 451-9692
(734) 451-9606
Mailing address
1330 CONGE DR, BLOOMFIELD HILLS, MI 48304-3005
(734) 451-9692
(734) 451-9606
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861002131
—
MI
Enumeration date
08/03/2020
Last updated
09/18/2020
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