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NPI Code Detail

MEDICARE: IVA N MALYNE

MEDICARE: IVA N MALYNE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker6801104567MI

General Provider Information

NPI Number : 1306404074
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVA N MALYNE
Provider Business Mailing Address
First Line : 3601 15 MILE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-5356
Country : US
Telephone Number : 586-722-7253
Fax Number : 586-722-7257
Provider Business Practice Location Address
First Line : 3601 15 MILE RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-5356
Country : US
Telephone Number : 586-722-7253
Fax Number : 586-722-7257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2019
Last Update Date : 05/29/2019

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Directions to “ IVA N MALYNE ” Practice Location

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