Provider Demographics
NPI:1790795045
Name:MALINZAK, LAUREN E (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:E
Last Name:MALINZAK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2799 WEST GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-916-7178
Mailing Address - Fax:313-916-4344
Practice Address - Street 1:2799 WEST GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-916-7178
Practice Address - Fax:313-916-4344
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072793208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII19710Medicare UPIN