Healthcare Provider Details

I. General information

NPI: 1255426730
Provider Name (Legal Business Name): SUSHIL K MALHOTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W KING ST STE B
OWOSOO MI
48867
US

IV. Provider business mailing address

802 W KING ST STE B
OWOSOO MI
48867
US

V. Phone/Fax

Practice location:
  • Phone: 989-725-9555
  • Fax:
Mailing address:
  • Phone: 989-725-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSM0404346
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: