Provider Demographics
NPI:1083010755
Name:HENRY FORD WEST BLOOMFIELD PHYSICANS
Entity type:Organization
Organization Name:HENRY FORD WEST BLOOMFIELD PHYSICANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KARCHON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-360-6000
Mailing Address - Street 1:PO BOX 674852
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-4852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39525 W 14 MILE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1632
Practice Address - Country:US
Practice Address - Phone:248-360-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty