Provider Demographics
NPI:1538504626
Name:NORTHWEST SURGICAL & MEDICAL COMPREHENSIVE SERVICES PC
Entity Type:Organization
Organization Name:NORTHWEST SURGICAL & MEDICAL COMPREHENSIVE SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDLIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-894-7881
Mailing Address - Street 1:9600 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1816
Mailing Address - Country:US
Mailing Address - Phone:313-894-7881
Mailing Address - Fax:
Practice Address - Street 1:9600 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1816
Practice Address - Country:US
Practice Address - Phone:313-894-7881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046832207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty