Active NPI
George Paul Malick, MD
- Dermatology Physician
- Troy, MI
National Provider Identifier
1750480869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 4301032495
- Practice address
- 38865 Dequindre Rd
Suite 104
Troy, MI 48083-6812 - Phone
- (248) 743-9330
- Fax
- (248) 743-9332
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301032495 | MI | Primary |
Addresses
Primary practice location
38865 Dequindre Rd
Suite 104
Troy, MI 48083-6812
Mailing address
38865 Dequindre Rd
Suite 104
Troy, MI 48083-6812
Phone (248) 743-9330
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0745000062 | Other | MI | BCBS OF MI |
| 1068315 | Medicaid | MI | |
| 0705022692 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Dermatology Center, PLLC | Dermatology | Past | Accepting new patients |
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.
-
- Dermatology Physician
- Troy, MI
- NPI 1649542689
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427932800000",
"number": "1750480869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "38865 DEQUINDRE RD",
"address_2": "SUITE 104",
"city": "TROY",
"state": "MI",
"postal_code": "480836812",
"telephone_number": "248-743-9330",
"fax_number": "248-743-9332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38865 DEQUINDRE RD",
"address_2": "SUITE 104",
"city": "TROY",
"state": "MI",
"postal_code": "480836812",
"telephone_number": "248-743-9330",
"fax_number": "248-743-9332"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALICK",
"first_name": "GEORGE",
"middle_name": "PAUL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-22",
"last_updated": "2015-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "MI",
"license": "4301032495",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MI",
"identifier": "0745000062",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1068315",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0705022692",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.