Provider Demographics
NPI:1134278104
Name:MALTO, ERANIO U (MD)
Entity type:Individual
Prefix:MR
First Name:ERANIO
Middle Name:U
Last Name:MALTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-720-1730
Mailing Address - Fax:810-720-1736
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-1730
Practice Address - Fax:810-720-1736
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033063207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050B56043OtherBLUE CROSSBLUE SHIELD
1172870001OtherTHE WELLNESS PLAN
MI1364608Medicaid
EM033063OtherHEALTH ALLIANCE PLAN
210425OtherMCLAREN HEALTH ADVANTAG
30946OtherCOMMUNITY CHOICE OF MI
AN250004OtherM CARE INC
0996930OtherHEALTH PLUS OF MICHIGAN
100110OtherGREAT LAKES HEALTH PLAN
4647093OtherAETNA HEALTH CARE
567567OtherSELECT CARE
EM033063OtherSTATE LICENSE NUMBER
210425OtherMCLAREN HEALTH PLAN
M001301OtherTRICARE REGION 2 AND 5
0B56043Medicare ID - Type Unspecified
050B56043OtherBLUE CROSSBLUE SHIELD
A79031Medicare UPIN