MEDICARE: BRUCE EDWARD CARL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301042852	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	700E012740	OTHER	MI	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1295796555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE EDWARD CARL MD

Provider Business Mailing Address
First Line	:	43750 GARFIELD RD
Second Line	:	SUITE 104
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1135
Country	:	US
Telephone Number	:	586-226-6860
Fax Number	:	586-226-6880

Provider Business Practice Location Address
First Line	:	64580 VAN DYKE RD
Second Line	:	SUITE C
City	:	WASHINGTON
State	:	MI
Zip	:	48095-2857
Country	:	US
Telephone Number	:	586-752-9629
Fax Number	:	586-752-4099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	05/21/2008

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Directions to “ BRUCE EDWARD CARL MD” Practice Location

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