Sushil K Malhotra, MD
Individual provider Active NPI Pediatrics Physician · Owosoo, MI
NPI 1255426730 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1255426730
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- SM0404346 (MI)
- Practice address
- 802 W King St Ste B
Owosoo, MI 48867 - Phone
- (989) 725-9555
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SM0404346 | MI | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | SM0404346 | MI | Yes |
Addresses
Primary practice location
802 W King St Ste B
Owosoo, MI 48867
Mailing address
802 W King St Ste B
Owosoo, MI 48867
Phone (989) 725-9555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1001336 | Other | MI | MCLAREN |
| 1820665 | Medicaid | MI | |
| 3507810331 | Other | MI | BCN |
| 1200037 | Other | MI | PHP |
| 1270037 | Other | MI | PHP/FC |
| 3507810331 | Other | MI | BCBS |
| 3507800292 | Other | MI | HEALTHPLUS |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.