Provider Demographics
NPI:1356511604
Name:MALA BATHIJA MD, PLLC
Entity Type:Organization
Organization Name:MALA BATHIJA MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MALATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHIJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-347-8285
Mailing Address - Street 1:44000 W 12 MILE RD
Mailing Address - Street 2:STE 212
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2644
Mailing Address - Country:US
Mailing Address - Phone:248-347-8285
Mailing Address - Fax:248-347-8215
Practice Address - Street 1:44000 W 12 MILE RD
Practice Address - Street 2:STE 212
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2644
Practice Address - Country:US
Practice Address - Phone:248-347-8285
Practice Address - Fax:248-347-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072526207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIY46439Medicare UPIN
MI0P25160Medicare PIN