Provider Demographics
NPI:1164484796
Name:MALHOTRA, PRAMIT S (MD)
Entity Type:Individual
Prefix:
First Name:PRAMIT
Middle Name:S
Last Name:MALHOTRA
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 1:900 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
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010867542086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH86195Medicare UPIN