Individual
MARVIC MALABANAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-5000
Mailing address
19467 ANTAGO ST, LIVONIA, MI 48152-2513
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
4704306606
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704306606
MI
Other
Enumeration date
04/30/2020
Last updated
09/28/2020
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