Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301053322 | MI |
N | 207PE0004X | Emergency Medical Services | 4301053322 | MI |
NPI | 1003853201 |
---|---|
Provider Name | Dr. Robert T Malinowski |
First Address | Detroit, MI 48201-2153 |
Second Address | Detroit, MI 48235-2624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102745681 | (05) | MI |
F10104 | (02) | MI |
RM053322 | BC/BS OF MICHIGAN (01) | MI |