MEDICARE: CARPENTER BANGLA MEDICAL CLINIC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1871749374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARPENTER BANGLA MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	3611 CARPENTER ST
Second Line	:	SUITE 5
City	:	DETROIT
State	:	MI
Zip	:	48212-2784
Country	:	US
Telephone Number	:	313-368-9502
Fax Number	:	313-368-9502

Provider Business Practice Location Address
First Line	:	3611 CARPENTER ST
Second Line	:	SUITE 5
City	:	DETROIT
State	:	MI
Zip	:	48212-2784
Country	:	US
Telephone Number	:	313-368-9502
Fax Number	:	313-368-9502

Authorized Official
Title or Position	:	OWNER
Name	:	ABDUL MABUD QUAZI
Credential	:	M.D
Telephone Number	:	313-368-9502

Provider Enumeration Date	:	08/15/2008
Last Update Date	:	08/15/2008

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