Individual
BRUCE EDWARD CARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
64580 VAN DYKE RD, SUITE C, WASHINGTON, MI 48095-2857
(586) 752-9629
(586) 752-4099
Mailing address
43750 GARFIELD RD, SUITE 104, CLINTON TWP, MI 48038-1135
(586) 226-6860
(586) 226-6880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301042852
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4373763
—
MI
01
—
700E012740
BCBS GROUP NUMBER
MI
Enumeration date
03/28/2006
Last updated
05/21/2008
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