Healthcare Provider Details

I. General information

NPI: 1245250315
Provider Name (Legal Business Name): RAYMOND MALEYKO JR. ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 N BECK RD
CANTON MI
48187-1210
US

IV. Provider business mailing address

28888 WESTFIELD ST
LIVONIA MI
48150-3137
US

V. Phone/Fax

Practice location:
  • Phone: 734-582-5697
  • Fax:
Mailing address:
  • Phone: 734-421-0508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: