Provider Demographics
NPI:1174520274
Name:ERNST, THOMAS KEVIN (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KEVIN
Last Name:ERNST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:5303 SHOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3137
Mailing Address - Country:US
Mailing Address - Phone:810-385-2053
Mailing Address - Fax:810-385-8763
Practice Address - Street 1:828 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3640
Practice Address - Country:US
Practice Address - Phone:810-982-4240
Practice Address - Fax:810-982-2479
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901000955213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958336Medicaid
MI1958336Medicaid
MI0423900001Medicare NSC
MIP44880001Medicare PIN