Healthcare Provider Details

I. General information

NPI: 1467074773
Provider Name (Legal Business Name): CRAIG HARGURKIRAT MALLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date: 01/11/2022
Reactivation Date: 01/27/2022

III. Provider practice location address

SPARROW HEALTH SYSTEM 1215 E MICHIGAN AVE
LANSING MI
48912
US

IV. Provider business mailing address

SPARROW HEALTH SYSTEM 1215 E MICHIGAN AVE
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5710
  • Fax:
Mailing address:
  • Phone: 517-364-5710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301508874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: