Individual
MARK DAVID MALNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 JEFFESON SE, GRAND RAPIDS, MI 49503
(616) 364-6700
(616) 364-4960
Mailing address
PO BOX 5329, SAGINAW, MI 48603-0329
(616) 364-6700
(989) 401-4245
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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