Provider Demographics
NPI:1104023118
Name:MALHOTRA, BINU (MD)
Entity Type:Individual
Prefix:
First Name:BINU
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1008
Mailing Address - Country:US
Mailing Address - Phone:989-912-6626
Mailing Address - Fax:989-912-6008
Practice Address - Street 1:4675 HILL ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1099
Practice Address - Country:US
Practice Address - Phone:989-912-6626
Practice Address - Fax:989-912-6008
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067713A207R00000X
MI4301097901207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104023118Medicaid
IN140220A4Medicare PIN
MIM74750432Medicare PIN