Provider Demographics
NPI:1730271107
Name:MALACZYNSKI, JADWIGA KAZIMIERA (MD)
Entity type:Individual
Prefix:
First Name:JADWIGA
Middle Name:KAZIMIERA
Last Name:MALACZYNSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 CARPENTER
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2783
Mailing Address - Country:US
Mailing Address - Phone:313-369-3365
Mailing Address - Fax:313-893-3875
Practice Address - Street 1:3120 CARPENTER
Practice Address - Street 2:SUITE 311
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-2783
Practice Address - Country:US
Practice Address - Phone:313-369-3365
Practice Address - Fax:313-893-3875
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJM061286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4272045Medicaid
MI0827662OtherBLUE CROSS BLUE SHIELD MI
MI0M79710Medicare ID - Type Unspecified
G90690Medicare UPIN