Healthcare Provider Details

I. General information

NPI: 1538194055
Provider Name (Legal Business Name): SAFWAN MALAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 410
LANSING MI
48912-1850
US

IV. Provider business mailing address

6192 WHITEHILLS LAKE DR
EAST LANSING MI
48823-9485
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5490
  • Fax: 517-364-5499
Mailing address:
  • Phone: 517-339-7750
  • Fax: 517-364-5499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4301060899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: