Provider Demographics
NPI:1285806836
Name:MALATI A PATEL
Entity type:Organization
Organization Name:MALATI A PATEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALATI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-286-4004
Mailing Address - Street 1:18645 CANAL RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5822
Mailing Address - Country:US
Mailing Address - Phone:586-286-4004
Mailing Address - Fax:586-286-1225
Practice Address - Street 1:18645 CANAL RD
Practice Address - Street 2:STE 3
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5822
Practice Address - Country:US
Practice Address - Phone:586-286-4004
Practice Address - Fax:586-286-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty