Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 4301051932 | MI |
NPI | 1215090840 |
---|---|
Provider Name | Michael S. Malian |
First Address | Dearborn, MI 48126-2778 |
Second Address | Dearborn, MI 48123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
472452810 | (05) | MI |
700H262310 | BLUE CROSS-BLUE CROSS (01) | |
F35746 | (02) | |
MM051932 | CHAMPUS-CHAMPUS (01) | |
MM051932 | COMMERCIAL-COMMERCIAL NUMBER (01) |