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General NPI Number Information
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NPI Number | 1831205517
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Entity Type | Individual
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Provider Name | KARL OYVIND BANDLIEN MD
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 39763 W HURON RIVER DR
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City | ROMULUS
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State | MI
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Zip | 48174-4807
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Country | US
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Telephone | 734-467-8565
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Fax | 734-467-8548
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Provider Business Mailing Address
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Address Line | 33000 PALMER RD
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City | WESTLAND
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State | MI
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Zip | 48186-5517
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Country | US
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Telephone | 734-467-8565
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Fax | 734-467-8548
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301046832
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License Number State | MI
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