Provider Demographics
NPI:1093730939
Name:MALHOTRA CENTER FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:MALHOTRA CENTER FOR PLASTIC SURGERY
Other - Org Name:ANN ARBOR PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMIT
Authorized Official - Middle Name:SOPHAT
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-789-9800
Mailing Address - Street 1:900 E MICHIGAN AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2457
Mailing Address - Country:US
Mailing Address - Phone:517-789-9800
Mailing Address - Fax:517-789-9801
Practice Address - Street 1:900 E MICHIGAN AVE
Practice Address - Street 2:STE 108
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2457
Practice Address - Country:US
Practice Address - Phone:517-789-9800
Practice Address - Fax:517-789-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH86195Medicare UPIN