Basic Information
| Provider Information | |||||||||
| NPI: | 1467074773 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLI | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | HARGURKIRAT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | SPARROW HEALTH SYSTEM | ||||||||
| Address2: | 1215 E MICHIGAN AVE | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173645710 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SPARROW HEALTH SYSTEM | ||||||||
| Address2: | 1215 E MICHIGAN AVE | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173645710 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2020 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 01/11/2022 | ||||||||
| NPIReactivationDate: | 01/27/2022 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4351046290 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.