Provider Demographics
NPI:1831205517
Name:BANDLIEN, KARL OYVIND (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:OYVIND
Last Name:BANDLIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:33000 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5517
Mailing Address - Country:US
Mailing Address - Phone:734-467-8565
Mailing Address - Fax:734-467-8548
Practice Address - Street 1:39763 W HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-4807
Practice Address - Country:US
Practice Address - Phone:734-467-8565
Practice Address - Fax:734-467-8548
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046832208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0820397OtherBC/BS OF MICHIGAN
MI4754287Medicaid
MI4754287Medicaid