| |
1404 Bridge St, Charlevoix, MI 49720-2603 | |
(231) 547-4662 | |
Not Available |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 1404 Bridge St, Charlevoix, Michigan |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1548445331 | NPI | - | NPPES |
4851550000 | Other | MI | BCBSM |
1441583 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | TD001078 (Michigan) | Primary |
Mailing Address | Practice Location Address |
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1773 Woodside Trl Nw, Grand Rapids, MI 49504-2580 Ph: (616) 453-1835 | 1404 Bridge St, Charlevoix, MI 49720-2603 Ph: (231) 547-4662 |
Dr. Thomas Bruce De Korte, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1404 Bridge St, Charlevoix, MI 49720 Phone: 231-547-4662 Fax: 231-547-3068 |