Individual
MICHELLE P. MALLITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5520 PARK AVE, 101, TRUMBULL, CT 06611-3463
(203) 371-5873
(203) 371-5874
Mailing address
5520 PARK AVE, 101, TRUMBULL, CT 06611-3463
(203) 371-5873
(203) 371-5874
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042937
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001429374
—
CT
Enumeration date
08/13/2006
Last updated
05/31/2013
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