Individual
MALI HIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2404 CHARLES ST, ROCKFORD, IL 61108-1602
(779) 696-7910
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301112477
MI
Other
Enumeration date
02/10/2011
Last updated
02/26/2021
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