Healthcare Provider Details

I. General information

NPI: 1295022424
Provider Name (Legal Business Name): HAZEM MALAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202
US

IV. Provider business mailing address

2940 N MCCORD RD
TOLEDO OH
43615-1753
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2871
  • Fax: 313-916-4513
Mailing address:
  • Phone: 419-842-3000
  • Fax: 419-291-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101019423
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101019423
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34.013510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: