Organization
THOMAS A MALEC MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS ANTHONY MALEC M.D. (PRESIDENT OF CORPORATION)
(616) 459-3564
Entity
Organization
Contact information
Practice address
515 LAKESIDE DR SE, SUITE 207, GRAND RAPIDS, MI 49506-2931
(616) 459-3564
(616) 459-3868
Mailing address
515 LAKESIDE DR SE, SUITE 207, GRAND RAPIDS, MI 49506-2931
(616) 459-3564
(616) 459-3868
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
4301026401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101059530
—
MI
Enumeration date
04/17/2008
Last updated
08/28/2008
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