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General NPI Number Information
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NPI Number | 1518302355
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Entity Type | Organization
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Legal Business Name | GROSSE POINTE SURGICAL & MEDICAL SERVICES PC
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 18348 MACK AVE
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City | GROSSE POINTE FARMS
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State | MI
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Zip | 48236-3219
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Country | US
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Telephone | 313-881-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 18348 MACK AVE
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City | GROSSE POINTE FARMS
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State | MI
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Zip | 48236-3219
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Country | US
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Telephone | 313-881-7010
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KARL BANDLIEN
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Credential | MD
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Telephone | 313-894-7881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301046832
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License Number State | MI
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