Healthcare Provider Details

I. General information

NPI: 1033438098
Provider Name (Legal Business Name): NAVEEN KUMAR MALAY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201, ST.ANTOINE
DETROIT MI
48201
US

IV. Provider business mailing address

4201, ST.ANTOINE, BOX 274
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-3430
  • Fax: 313-577-8600
Mailing address:
  • Phone: 313-745-3430
  • Fax: 313-577-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number4301091875
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301091875
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301091875
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: