1346414620 NPI number — THOMAS A MALEC MD PC

Table of content: (NPI 1346414620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346414620 NPI number — THOMAS A MALEC MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS A MALEC MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346414620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 LAKESIDE DR SE
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49506-2931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-459-3564
Provider Business Mailing Address Fax Number:
616-459-3868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 LAKESIDE DR SE
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49506-2931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-459-3564
Provider Business Practice Location Address Fax Number:
616-459-3868
Provider Enumeration Date:
04/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MALEC
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT OF CORPORATION
Authorized Official Telephone Number:
616-459-3564

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  4301026401 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101059530 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com