Malcom, Latisha M
Malcom, Latisha M is an individual health care provider with primary practice located at 6455 Gratiot Ave , Detroit MI 48207-1808. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Malcom, Latisha M can be contacted via phone (313) 921-8600.Contact Information
Primary practice address
6455 Gratiot Ave
Detroit MI 48207-1808
Phone: (313) 921-8600
Fax: (313) 921-1712
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 4301070929 | Michigan |
Profile Details
| NPI number | 1114999430 |
|---|---|
| LBN Legal business name | Malcom, Latisha M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 2nd, 2006 |
| Last updated | May 12th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114999430 | NPPES |
| Michigan | MEDICAID | 4604232-10 |
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