Healthcare Provider Details

I. General information

NPI: 1285282798
Provider Name (Legal Business Name): MALAVIKA PRASEED MCGRAIL LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 W 400 N
MICHIGAN CITY IN
46360-9330
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-861-5800
  • Fax: 219-861-5543
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number74000305A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: