Basic Information
| Provider Information | |||||||||
| NPI: | 1902848666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALSHESKE | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 HANNAH BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173191831 | ||||||||
| FaxNumber: | 5176642930 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 HANNAH BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173191831 | ||||||||
| FaxNumber: | 5176642930 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 08/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601004695 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1059905 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | MA802693 | 01 | CO | BCBS | OTHER | 0N61290016 | 01 | MI | MEDICARE PLUS BLUE/MEDICARE ADVANTAGE | OTHER | 2053303550 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | MM1399004 | 01 | MI | DEA | OTHER | 1059905 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1059905 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 7556753 | 01 | MI | AETNA | OTHER |