Provider Demographics
NPI:1093730939
Name:MALHOTRA CENTER FOR PLASTIC SURGERY
Entity type:Organization
Organization Name:MALHOTRA CENTER FOR PLASTIC SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMIT
Authorized Official - Middle Name:SOPHAT
Authorized Official - Last Name:MALHOTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-913-5100
Mailing Address - Street 1:2320 WASHTENAW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4558
Mailing Address - Country:US
Mailing Address - Phone:734-913-5100
Mailing Address - Fax:734-913-5110
Practice Address - Street 1:2320 WASHTENAW AVE STE A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4558
Practice Address - Country:US
Practice Address - Phone:734-913-5100
Practice Address - Fax:734-913-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH86195Medicare UPIN