Provider Demographics
NPI:1164484796
Name:MALHOTRA, PRAMIT S (MD)
Entity type:Individual
Prefix:
First Name:PRAMIT
Middle Name:S
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 WASHTENAW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4558
Mailing Address - Country:US
Mailing Address - Phone:734-913-5100
Mailing Address - Fax:734-913-5110
Practice Address - Street 1:2320 WASHTENAW AVE STE A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4558
Practice Address - Country:US
Practice Address - Phone:734-913-5100
Practice Address - Fax:734-913-5110
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010867542086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH86195Medicare UPIN