Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 4301086754 | MI |
NPI | 1164484796 |
---|---|
Provider Name | Pramit S Malhotra |
First Address | Jackson, MI 49201-2457 |
Second Address | Jackson, MI 49201-2457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 09/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H86195 | (02) | MI |