David Malicke, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

5101006437 Issued in MI

Practice address

5450 Fort St
Emergency Medicine Department
Trenton, MI 48183-4601

Phone

(734) 671-3883

Fax

(734) 671-3546

NPI assigned

Jan 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Professionals of Michigan, P.C.

  • Emergency Medicine Physician
  • Dearborn, MI
  • NPI 1952740656
  Medicare reassignment NPD
• St John Oakland Hospital

  • General Acute Care Hospital
  • Warren, MI
  • NPI 1942271671
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1043298342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2764 NEW ENGLAND DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483092818",
            "telephone_number": "734-632-0175",
            "fax_number": "734-632-0182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5450 FORT ST",
            "address_2": "EMERGENCY MEDICINE DEPARTMENT",
            "city": "TRENTON",
            "state": "MI",
            "postal_code": "481834601",
            "telephone_number": "734-671-3883",
            "fax_number": "734-671-3546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALICKE",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101006437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1043298342",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1156338864",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob Dante Lupini, DDS
• Genny Lynn Luppino, LPC
• Morgan Rose Lyons
• Elizabeth Marie Macdonald
• Katherine Grace Mackillop, DO
• Darin L Mann, DO
• Marcia Vanderbroek DO PC
• Margaret a Lutsic DO PC
• Emery Martin
• Leshia Rene Martino

• Emergency Medicine Physician in Trenton, MI
• Providers in Trenton, MI by specialty
• Emergency Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.