Raj Malosh, PRC

Key facts

NPI

1063190874

Entity type

Individual (NPI type 1)

Primary specialty

Peer Specialist 175T00000X

Practice address

913 W Holmes Rd Ste 200
Lansing, MI 48910-0411

Phone

(517) 887-0226

NPI assigned

Jul 11, 2023

Sex

Male

Sole proprietor

No

Organizations & group practices 1

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.

• Mid-Michigan Recovery Services, Inc. Substance Use Disorder Rehabilitation Clinic/Center · Lansing, MI · NPI 1255386124
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 11, 2023.

{
    "created_epoch": "1689033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1063190874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6265 FENWICK CT",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488239210",
            "telephone_number": "517-899-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 W HOLMES RD STE 200",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489100411",
            "telephone_number": "517-887-0226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALOSH",
        "first_name": "RAJ",
        "credential": "PRC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-11",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Lansing, MI · Peer Specialist in Michigan