Healthcare Provider Details

I. General information

NPI: 1881867984
Provider Name (Legal Business Name): BULENT OZGONENEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

3800 WOODWARD AVE SUITE 600
DETROIT MI
48201-2061
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301074930
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: