Healthcare Provider Details

I. General information

NPI: 1992757645
Provider Name (Legal Business Name): ALEXANDER MALAYEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HOLLY RD
GRAND BLANC MI
48439-1812
US

IV. Provider business mailing address

5374 BRISTOL PARKE DR
CLARKSTON MI
48348-4828
US

V. Phone/Fax

Practice location:
  • Phone: 810-695-8011
  • Fax: 810-695-8002
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301082525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: