Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301089143 | MI |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD426319 | PA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 4301089143 | MI |
NPI | 1588792097 |
---|---|
Provider Name | Miss Kelly Michele Malloy |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 31/08/2012 |