Provider Demographics
NPI:1003026873
Name:STEIDER, MALCOLM DARRYL (MD)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:DARRYL
Last Name:STEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 STILLMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7859
Mailing Address - Country:US
Mailing Address - Phone:517-545-0359
Mailing Address - Fax:
Practice Address - Street 1:4988 STILLMEADOW DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7859
Practice Address - Country:US
Practice Address - Phone:517-545-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010292232080H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301029223OtherPHYSIAN LISCENCE #