Provider Demographics
NPI:1538194055
Name:MALAS, SAFWAN (MD)
Entity type:Individual
Prefix:DR
First Name:SAFWAN
Middle Name:
Last Name:MALAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6192 WHITEHILLS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9485
Mailing Address - Country:US
Mailing Address - Phone:517-339-7750
Mailing Address - Fax:517-364-5499
Practice Address - Street 1:1200 E MICHIGAN AVE STE 410
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1850
Practice Address - Country:US
Practice Address - Phone:517-364-5490
Practice Address - Fax:517-364-5499
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010608992080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology