Healthcare Provider Details

I. General information

NPI: 1346414620
Provider Name (Legal Business Name): THOMAS A MALEC MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LAKESIDE DR SE SUITE 207
GRAND RAPIDS MI
49506-2931
US

IV. Provider business mailing address

515 LAKESIDE DR SE SUITE 207
GRAND RAPIDS MI
49506-2931
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-3564
  • Fax: 616-459-3868
Mailing address:
  • Phone: 616-459-3564
  • Fax: 616-459-3868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4301026401
License Number StateMI

VIII. Authorized Official

Name: DR. THOMAS ANTHONY MALEC
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 616-459-3564