Active NPI
Jacob Mallad, DO
- Family Medicine Physician
- Novi, MI
National Provider Identifier
1932890225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101029462
- Practice address
- 28455 Haggerty Rd
Novi, MI 48377-2982 - Phone
- (248) 553-2200
- NPI assigned
- May 17, 2023
- Last updated
- Jun 6, 2026
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101029462 | MI | Primary |
Addresses
Primary practice location
28455 Haggerty Rd
Novi, MI 48377-2982
Mailing address
28455 Haggerty Rd Ste 100
Novi, MI 48377-2982
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260618001607 | MI | Practitioner - Family Practice | 7315303831 |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Michigan State University College of Osteopathic Medicine, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
15855 19 Mile Rd
Clinton Township, MI 48038-6324
18053 Devonshire CT
Northville, MI 48168-8563
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101029462 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780704000000",
"number": "1932890225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28455 HAGGERTY RD STE 100",
"city": "NOVI",
"state": "MI",
"postal_code": "483772982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28455 HAGGERTY RD",
"city": "NOVI",
"state": "MI",
"postal_code": "483772982",
"telephone_number": "248-553-2200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLAD",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-17",
"last_updated": "2026-06-06",
"certification_date": "2026-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101029462",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.