Provider Demographics
NPI:1871749374
Name:CARPENTER BANGLA MEDICAL CLINIC
Entity type:Organization
Organization Name:CARPENTER BANGLA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:MABUD
Authorized Official - Last Name:QUAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-368-9502
Mailing Address - Street 1:3611 CARPENTER ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2784
Mailing Address - Country:US
Mailing Address - Phone:313-368-9502
Mailing Address - Fax:313-368-9502
Practice Address - Street 1:3611 CARPENTER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2784
Practice Address - Country:US
Practice Address - Phone:313-368-9502
Practice Address - Fax:313-368-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty