Provider Demographics
NPI:1902848666
Name:MALSHESKE, DANIEL MATTHEW (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MATTHEW
Last Name:MALSHESKE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 HANNAH BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5384
Mailing Address - Country:US
Mailing Address - Phone:517-319-1831
Mailing Address - Fax:517-664-2930
Practice Address - Street 1:2900 HANNAH BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5384
Practice Address - Country:US
Practice Address - Phone:517-319-1831
Practice Address - Fax:517-664-2930
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1059905OtherMCLAREN HEALTH PLAN-MEDICAID
COMA802693OtherBCBS
MI0N61290016OtherMEDICARE PLUS BLUE/MEDICARE ADVANTAGE
MI2053303550OtherBLUE CROSS BLUE SHIELD
MI1059905OtherMCLAREN HEALTH ADVANTAGE
MI1059905OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI7556753OtherAETNA
MI7556753OtherAETNA
MI2053303550OtherBLUE CROSS BLUE SHIELD
MIN82650006Medicare ID - Type Unspecified
COC811733Medicare PIN
MIMM1399004OtherDEA
MIN61290016Medicare PIN