Healthcare Provider Details

I. General information

NPI: 1215090840
Provider Name (Legal Business Name): MICHAEL S. MALIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 OAKWOOD BOULEVARD BEAUMONT HOSPITAL, DEARBORN TRAUMA SVCS
DEARBORN MI
48123
US

IV. Provider business mailing address

15500 LUNDY PKWY
DEARBORN MI
48126-2778
US

V. Phone/Fax

Practice location:
  • Phone: 313-982-5440
  • Fax: 313-982-5445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301051932
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: