Healthcare Provider Details

I. General information

NPI: 1568722981
Provider Name (Legal Business Name): DEVIN BIRSINGH MALIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE STE 307
JACKSON MI
49201-1850
US

IV. Provider business mailing address

205 N. EAST AVENUE PROVIDER ENROLLMENT
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1594
  • Fax: 517-205-5229
Mailing address:
  • Phone: 517-205-3867
  • Fax: 517-803-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301100683
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number4301100683
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301100683
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301100683
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: