Healthcare Provider Details

I. General information

NPI: 1174520274
Provider Name (Legal Business Name): THOMAS KEVIN ERNST DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 10TH AVE
PORT HURON MI
48060-3640
US

IV. Provider business mailing address

5303 SHOREWOOD DR
FORT GRATIOT MI
48059-3137
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-4240
  • Fax: 810-982-2479
Mailing address:
  • Phone: 810-385-2053
  • Fax: 810-385-8763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901000955
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: