Provider Demographics
NPI:1891786687
Name:MALI, VISHWANATH B (MD)
Entity Type:Individual
Prefix:DR
First Name:VISHWANATH
Middle Name:B
Last Name:MALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:STE 510
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1038
Mailing Address - Country:US
Mailing Address - Phone:586-323-6300
Mailing Address - Fax:586-323-6331
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:STE 510
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-323-6300
Practice Address - Fax:586-323-6331
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-05-14
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Provider Licenses
StateLicense IDTaxonomies
MI4301034236208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2100444Medicaid
MI2100444Medicaid