MEDICARE: DR. VISHWANATH B MALI MD

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
1	208000000X	Pediatrics Physician	4301034236	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891786687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VISHWANATH B MALI MD

Provider Business Mailing Address
First Line	:	44344 DEQUINDRE RD
Second Line	:	STE 510
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1038
Country	:	US
Telephone Number	:	586-323-6300
Fax Number	:	586-323-6331

Provider Business Practice Location Address
First Line	:	44344 DEQUINDRE RD
Second Line	:	STE 510
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-1038
Country	:	US
Telephone Number	:	586-323-6300
Fax Number	:	586-323-6331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/14/2009

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