Healthcare Provider Details

I. General information

NPI: 1831205517
Provider Name (Legal Business Name): KARL OYVIND BANDLIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39763 W HURON RIVER DR
ROMULUS MI
48174-4807
US

IV. Provider business mailing address

33000 PALMER RD
WESTLAND MI
48186-5517
US

V. Phone/Fax

Practice location:
  • Phone: 734-467-8565
  • Fax: 734-467-8548
Mailing address:
  • Phone: 734-467-8565
  • Fax: 734-467-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301046832
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: