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
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