Individual
LATISHA M MALCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2700 HAMLIN BLVD, INKSTER, MI 48141-2206
(313) 561-5100
(313) 565-0309
Mailing address
2700 HAMLIN BLVD, INKSTER, MI 48141-2206
(313) 561-5100
(313) 565-0309
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301070929
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4604232-10
—
MI
Enumeration date
02/02/2006
Last updated
03/25/2026
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