Bruce Edward Carl, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301042852 Issued in MI

Practice address

64580 Van Dyke Rd
Suite C
Washington, MI 48095-2857

Phone

(586) 752-9629

Fax

(586) 752-4099

NPI assigned

Mar 28, 2006

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 21, 2008.

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1295796555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43750 GARFIELD RD",
            "address_2": "SUITE 104",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480381135",
            "telephone_number": "586-226-6860",
            "fax_number": "586-226-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64580 VAN DYKE RD",
            "address_2": "SUITE C",
            "city": "WASHINGTON",
            "state": "MI",
            "postal_code": "480952857",
            "telephone_number": "586-752-9629",
            "fax_number": "586-752-4099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARL",
        "first_name": "BRUCE",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301042852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4373763",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "700E012740",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rebecca Elizabeth Bussell, FNP-C
• Brett W Butler, D.P.M.
• Dayna Calka
• Holly Campbell, LCSW
• Rachelle Kristen Campbell, LPC
• Jennifer Carlton, D.O.
• Maria L Cejmer, LMT, BCTMB
• Rosie Maxine Chapman, LMSW
• Kim Bernard Chronis, RPH
• Joann Louise Coleman, LMSW

• All providers in Washington, MI
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.