Charbal B Bazo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301058428 Issued in MI

Practice address

1641 10TH St
Suite B
Port Huron, MI 48060-5844

Phone

(810) 987-7200

Fax

(810) 987-5396

NPI assigned

Mar 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physician Healthcare Network, PC

  • Family Medicine Physician
  • Marysville, MI
  • NPI 1750334405

  Internal Medicine

  NPD

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292889600000",
    "number": "1689643496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 10TH ST",
            "address_2": "SUITE B",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605844",
            "telephone_number": "810-987-7200",
            "fax_number": "810-987-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 10TH ST",
            "address_2": "SUITE B",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480605844",
            "telephone_number": "810-987-7200",
            "fax_number": "810-987-5396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZO",
        "first_name": "CHARBAL",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2010-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301058428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689643496",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brendan Bauer
• Jodi Bauer
• John Vincent Baugh, M.D.
• Hannah Marie Bautel
• Sarah Bazido
• Erica Bazydlo, RN
• Beacon Home Care, LLC
• Jeanna Beatty
• Jessica Jean Beatty
• Kate Carol Beauchamp, DDS

• Internal Medicine Physician in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; 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.