Provider Demographics
NPI:1215090840
Name:MALIAN, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MALIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15500 LUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BOULEVARD
Practice Address - Street 2:BEAUMONT HOSPITAL, DEARBORN TRAUMA SVCS
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48123
Practice Address - Country:US
Practice Address - Phone:313-982-5440
Practice Address - Fax:313-982-5445
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010519322086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM051932OtherCHAMPUS-CHAMPUS
MI472452810Medicaid
700H262310OtherBLUE CROSS-BLUE CROSS
MM051932OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262310OtherBLUE CROSS-BLUE CROSS
MM051932OtherCOMMERCIAL-COMMERCIAL NUMBER