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General NPI Number Information
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NPI Number | 1003613654
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Entity Type | Individual
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Provider Name | MALIK LAURY
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Gender | Male
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 1200 S. TELEGRAPH BUILDING 32 EAST
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City | PONTIAC
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State | MI
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Zip | 48341
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Country | US
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Telephone | 800-231-1127
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Fax |
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Provider Business Mailing Address
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Address Line | 12808 WADE ST
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City | DETROIT
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State | MI
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Zip | 48213-1867
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 2003096
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License Number State | MI
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