Provider Demographics
NPI:1962675207
Name:METROPOLITAN DERMATOLOGY CENTER, P.C.
Entity Type:Organization
Organization Name:METROPOLITAN DERMATOLOGY CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MALICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-743-9330
Mailing Address - Street 1:38865 DEQUINDRE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6812
Mailing Address - Country:US
Mailing Address - Phone:248-743-9330
Mailing Address - Fax:248-743-9332
Practice Address - Street 1:38865 DEQUINDRE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6812
Practice Address - Country:US
Practice Address - Phone:248-743-9330
Practice Address - Fax:248-743-9332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032495174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0705022692OtherBCBS
MI1068315Medicaid
MI1068315Medicaid
4500006Medicare PIN