Light of Hope Family Medical Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

4301046832 Issued in MI

Legal business name

LIGHT OF HOPE FAMILY MEDICAL CLINIC

Practice address

9600 Dexter Ave
Detroit, MI 48206-1816

Phone

(313) 894-7881

Fax

(313) 894-6312

NPI assigned

Mar 28, 2014

Last updated

Mar 28, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Karl Bandlien, M.D.

Title

President

Phone

(313) 894-7881

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395964800000",
    "number": "1497172381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9600 DEXTER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482061816",
            "telephone_number": "313-894-7881",
            "fax_number": "313-894-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 DEXTER AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482061816",
            "telephone_number": "313-894-7881",
            "fax_number": "313-894-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHT OF HOPE FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-28",
        "last_updated": "2014-03-28",
        "status": "A",
        "authorized_official_last_name": "BANDLIEN",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-894-7881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MI",
            "license": "4301046832",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "0820397",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4754287",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in Detroit, MI
• Providers in Detroit, MI by specialty
• Multi-Specialty Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2014; 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.