Individual
ASHLEY RENEE MALLIETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
3080 RANEEM DR, COMMERCE TOWNSHIP, MI 48382-5204
(313) 695-2503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005984
MI
Other
Enumeration date
04/25/2011
Last updated
03/04/2021
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