Provider Demographics
NPI:1124085436
Name:BATHIJA, MALATHI (MD)
Entity type:Individual
Prefix:
First Name:MALATHI
Middle Name:
Last Name:BATHIJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44000 W 12 MILE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2644
Mailing Address - Country:US
Mailing Address - Phone:248-347-8285
Mailing Address - Fax:248-347-8215
Practice Address - Street 1:44000 W 12 MILE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2644
Practice Address - Country:US
Practice Address - Phone:248-347-8285
Practice Address - Fax:248-347-8215
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072526207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIY46439Medicare UPIN
MI0P25160Medicare ID - Type Unspecified