Basic Information
| Provider Information | |||||||||
| NPI: | 1538194055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALAS | ||||||||
| FirstName: | SAFWAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6192 WHITEHILLS LAKE DR | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488239485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173397750 | ||||||||
| FaxNumber: | 5173645499 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 E MICHIGAN AVE STE 410 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173645490 | ||||||||
| FaxNumber: | 5173645499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | 4301060899 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
No ID Information.