Individual
DR. MALLORY CHRISTINE NAGARAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
15675 NORTHLINE RD, SOUTHGATE, MI 48195-2334
(734) 282-3600
(734) 282-3603
Mailing address
1640 FORT ST SUITE D, ATTN DENISE, TRENTON, MI 48183
(734) 391-3057
(734) 391-3052
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101019837
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H24657
BLUE CROSS
MI
01
—
1457586646
GROUP NPI HENRY FORD WYANDOTTE
—
Enumeration date
03/19/2012
Last updated
02/22/2017
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