Provider Demographics
NPI:1790006328
Name:JADWIGA MALACZYNSKI, M.D.,PC
Entity Type:Organization
Organization Name:JADWIGA MALACZYNSKI, M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JADWIGA
Authorized Official - Middle Name:KAZIMIERA
Authorized Official - Last Name:MALACZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-369-3365
Mailing Address - Street 1:3120 CARPENTER
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2783
Mailing Address - Country:US
Mailing Address - Phone:313-369-3365
Mailing Address - Fax:313-893-3875
Practice Address - Street 1:3120 CARPENTER
Practice Address - Street 2:SUITE 311
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2783
Practice Address - Country:US
Practice Address - Phone:313-369-3365
Practice Address - Fax:313-893-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061286207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0827662OtherBLUE CROSS BLUE SHIELD
MI4272045Medicaid
MIG90690Medicare UPIN
MI0M79710Medicare PIN