Provider Demographics
NPI:1255426730
Name:MALHOTRA, SUSHIL K (MD)
Entity type:Individual
Prefix:
First Name:SUSHIL
Middle Name:K
Last Name:MALHOTRA
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 1:802 W KING ST STE B
Mailing Address - Street 2:
Mailing Address - City:OWOSOO
Mailing Address - State:MI
Mailing Address - Zip Code:48867
Mailing Address - Country:US
Mailing Address - Phone:989-725-9555
Mailing Address - Fax:
Practice Address - Street 1:802 W KING ST STE B
Practice Address - Street 2:
Practice Address - City:OWOSOO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-725-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISM0404346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001336OtherMCLAREN
MI1820665Medicaid
MI3507810331OtherBCN
MI1200037OtherPHP
MI1270037OtherPHP/FC
MI3507810331OtherBCBS
MI3507800292OtherHEALTHPLUS
MI1820665Medicaid