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General NPI Number Information
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NPI Number | 1619054160
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Entity Type | Organization
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Legal Business Name | BLUE WATER ONCOLOGY PC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2605 ELECTRIC AVE
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City | PORT HURON
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State | MI
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Zip | 48060-6590
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Country | US
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Telephone | 810-985-1670
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Fax | 810-982-9180
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Provider Business Mailing Address
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Address Line | 2605 ELECTRIC AVE
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City | PORT HURON
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State | MI
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Zip | 48060-6590
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Country | US
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Telephone | 810-985-1670
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Fax | 810-982-9180
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBORAH SCHEFFLER
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Credential |
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Telephone | 810-985-1670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 4301054609
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License Number State | MI
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