Healthcare Provider Details

I. General information

NPI: 1831611870
Provider Name (Legal Business Name): VINAY K MALVIYA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY STE 530
NOVI MI
48374-1268
US

IV. Provider business mailing address

4610 CIMARRON DR
BLOOMFIELD TOWNSHIP MI
48302-2216
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-5104
  • Fax: 248-465-5103
Mailing address:
  • Phone: 248-539-3956
  • Fax: 248-539-3954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number4301046543
License Number StateMI

VIII. Authorized Official

Name: VINAY K MALVIYA
Title or Position: PHYSICIAN
Credential: MD
Phone: 248-465-5104