Healthcare Provider Details

I. General information

NPI: 1932281672
Provider Name (Legal Business Name): MALI & MALI PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 DEQUINDRE RD SUITE 502
TROY MI
48085-1128
US

IV. Provider business mailing address

44199 DEQUINDRE RD SUITE 502
TROY MI
48085-1128
US

V. Phone/Fax

Practice location:
  • Phone: 248-828-3888
  • Fax: 248-828-1952
Mailing address:
  • Phone: 248-828-3888
  • Fax: 248-828-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: VISHWANATH B MALI
Title or Position: PRESIDENT
Credential:
Phone: 248-828-3888