Individual
ERIC MICHAEL MALLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
486 RANDALL RD UNIT B, SOUTH ELGIN, IL 60177-3354
(224) 783-5000
Mailing address
35472 FREDERICKSBURG RD, FARMINGTON HILLS, MI 48331-2530
(248) 994-0106
(248) 994-0106
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036.125880
IL
207Q00000X
Family Medicine Physician
01094571A
IN
207Q00000X
Family Medicine Physician
Primary
036.125880
IL
207Q00000X
Family Medicine Physician
4301090660
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300095036
—
IN
01
—
700H231390
BCBS GROUP NUMBER
MI
Enumeration date
06/29/2007
Last updated
08/29/2024
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