Port Huron Bone and Joint Surgery PC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

PORT HURON BONE AND JOINT SURGERY PC

Practice address

1985 Gratiot Blvd
Marysville, MI 48040-2215

Phone

(734) 451-9692

Fax

(734) 451-9606

NPI assigned

Aug 3, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert D Travis, MD

Title

Owner

Phone

(734) 451-9692

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1861002131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 CONGE DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483043005",
            "telephone_number": "734-451-9692",
            "fax_number": "734-451-9606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1985 GRATIOT BLVD",
            "city": "MARYSVILLE",
            "state": "MI",
            "postal_code": "480402215",
            "telephone_number": "734-451-9692",
            "fax_number": "734-451-9606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT HURON BONE AND JOINT SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-03",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A",
        "authorized_official_last_name": "TRAVIS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-451-9692",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1861002131",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Physician Healthcare Network, PC
• Physician Healthcare Network, PC
• Cynthia L Pittman
• Jessica Plum
• Katelyn Marie Pokoj
• Ashley Elizabeth Porter
• Timothy Jene Porter
• Edgar Allan Pou, M,D.
• Ariah Cristine Pouzar
• Dianna Lynn Pratt, PSYD

• Orthopaedic Surgery Physician in Marysville, MI
• Providers in Marysville, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.