Nicole M Mallory, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

5601003330 Issued in MI

Practice address

28800 Ryan Rd
Warren, MI 48092-4272

Phone

(586) 573-6400

Fax

(586) 576-1918

NPI assigned

Mar 14, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Home Medical Services PC

  • General Practice Physician
  • Detroit, MI
  • NPI 1407039076
  NPD (past)
• Seniors Wellness Group of Michigan, P.C.

  • Clinical Psychologist
  • Royal Oak, MI
  • NPI 1801848718
  NPD (past)
• Geriatric Psychiatric Services PLLC

  • Clinical Psychologist
  • Indianapolis, IN
  • NPI 1073753323
  NPD (past)

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

{
    "created_epoch": "1205452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205712000000",
    "number": "1578734844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 WASHINGTON BLVD",
            "address_2": "APT 1716",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482261732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28800 RYAN RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480924272",
            "telephone_number": "586-573-6400",
            "fax_number": "586-576-1918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLORY",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-03-14",
        "last_updated": "2008-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601003330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sudheer B Malgireddy
• Dua Malik, DO
• Anita Malina-Litkowiec
• Voitek Malinowski, PT
• Riva Linda Malki, PHARMD
• Juanada Malone
• Janet Sue Malosh, DPT
• Lindsay Malzahn
• Samuel D Manalo, M.D.
• Emma Kristine Mandouh, NP

• Medical Physician Assistant in Warren, MI
• Providers in Warren, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.