Provider Demographics
NPI:1891248225
Name:KRZYSZTOF MLAK, MD,PC
Entity type:Organization
Organization Name:KRZYSZTOF MLAK, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRZYSZTOF
Authorized Official - Middle Name:
Authorized Official - Last Name:MLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-838-6893
Mailing Address - Street 1:200 RIVER PLACE DR APT 24
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4400
Mailing Address - Country:US
Mailing Address - Phone:586-838-6893
Mailing Address - Fax:844-269-7554
Practice Address - Street 1:1525 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2673
Practice Address - Country:US
Practice Address - Phone:810-794-7750
Practice Address - Fax:844-269-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430109066942084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6033Medicare PIN