Provider Demographics
NPI:1801075395
Name:PRAVEEN K MALHOTRA MD INC
Entity type:Organization
Organization Name:PRAVEEN K MALHOTRA MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANN
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-227-4472
Mailing Address - Street 1:531 S EASTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805
Mailing Address - Country:US
Mailing Address - Phone:419-227-4472
Mailing Address - Fax:419-229-9233
Practice Address - Street 1:531 S EASTOWN ROAD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805
Practice Address - Country:US
Practice Address - Phone:419-227-4472
Practice Address - Fax:419-229-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630246Medicaid
9352291Medicare PIN
OH2630246Medicaid