Healthcare Provider Details

I. General information

NPI: 1508954603
Provider Name (Legal Business Name): BLUE WATER OB & GYN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 STONE ST
PORT HURON MI
48060-3520
US

IV. Provider business mailing address

1313 STONE ST
PORT HURON MI
48060-3520
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-3559
  • Fax: 810-985-5196
Mailing address:
  • Phone: 810-984-3559
  • Fax: 810-985-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC JAMES HARTMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 810-984-3559