Provider Demographics
NPI:1225051600
Name:C MALDE, M.D., P.C.
Entity Type:Organization
Organization Name:C MALDE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHANDULAL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MALDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-877-7376
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT NUMBER 77151
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:810-877-7376
Mailing Address - Fax:810-230-9368
Practice Address - Street 1:5050 VILLA LINDE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3436
Practice Address - Country:US
Practice Address - Phone:810-877-7376
Practice Address - Fax:810-230-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P12670Medicare ID - Type Unspecified
MIE38261Medicare UPIN