Individual
MARK DAVID MALNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301048475
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1662851100
—
MI
01
—
300044873
RR MEDICAID
MI
Enumeration date
07/27/2006
Last updated
09/10/2019
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