Organization
LIGHT OF HOPE FAMILY MEDICAL CLINIC
Active
Organization
LIGHT OF HOPE FAMILY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARL BANDLIEN M.D. (PRESIDENT)
(313) 894-7881
Entity
Organization
Contact information
Practice address
9600 DEXTER AVE, DETROIT, MI 48206-1816
(313) 894-7881
(313) 894-6312
Mailing address
9600 DEXTER AVE, DETROIT, MI 48206-1816
(313) 894-7881
(313) 894-6312
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
4301046832
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0820397
BCBS OF MICHIGAN
MI
05
—
4754287
—
MI
Enumeration date
03/28/2014
Last updated
03/28/2014
Update your record
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