Provider Demographics
NPI:1225218738
Name:MALARSH FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:MALARSH FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGAINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-920-2666
Mailing Address - Street 1:31731 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 156 W
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1654
Mailing Address - Country:US
Mailing Address - Phone:313-920-2666
Mailing Address - Fax:
Practice Address - Street 1:31731 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 156 W
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1654
Practice Address - Country:US
Practice Address - Phone:313-920-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM069572305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH12400Medicare UPIN