Individual
CHARBAL B BAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1641 10TH ST, SUITE B, PORT HURON, MI 48060-5844
(810) 987-7200
(810) 987-5396
Mailing address
1641 10TH ST, SUITE B, PORT HURON, MI 48060-5844
(810) 987-7200
(810) 987-5396
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301058428
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689643496
—
MI
Enumeration date
03/15/2006
Last updated
12/21/2010
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