LATISHA M MALCOM (NPI# 1114999430) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114999430 |
| Entity Type | Individual |
| Full Name | LATISHA M MALCOM |
| Credential | M.D. |
| Practice Address |
6455 Gratiot Ave Detroit MI 48207-1808 |
| Mailing Address |
28801 Plymouth Rd Livonia MI 48150-2385 |
| Practice Telephone | 3139218600 |
| Practice Fax Number | 3139211712 |
| Mailing Telephone | 7342662780 |
| Mailing Fax Number | 7344669615 |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2011-05-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 4301070929 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4604232-10 | 05 |
| Street Address |
6455 GRATIOT AVE |
| City | DETROIT |
| State | MI |
| Zip Code | 48207-1808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255324059 | Kd Pharmacy, Inc. | Pharmacy | 6455 Gratiot Ave, Detroit, MI 48207-1808 | 2005-08-26 |
| 1174040026 | Detroit Pharmacy LLC | Pharmacy | 6455 Gratiot Ave, Detroit, MI 48207-1808 | 2017-08-22 |
| 1053610618 | Fitness Physical Therapy LLC | Clinic/Center | 6455 Gratiot Ave, Detroit, MI 48207-1808 | 2011-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245848506 | Anton R Gonzales | Physical Therapy Assistant | 2295 Chene, Detroit, Mi 48207, Detroit, MI 48207 | 2020-07-22 |
| 1033733928 | Taleshia Moss | Occupational Therapist | 2295 Chene, Detroit, MI 48207 | 2020-06-05 |
| 1942858550 | Ronald Royce Cochran | Counselor | 2925 Russell St, Detroit, Detroit, MI 48207 | 2019-08-27 |
| 1649831439 | Charday Penick | Social Worker | Team Wellness, 2925 Russell St, Detroit, MI 48207 | 2019-06-24 |
| 1568023349 | Alphia Ramona Burgess | Social Worker | Team Wellness Center, 2925 Russell Street, Detroit, MI 48207 | 2019-06-24 |
| 1447741608 | Sherice Ward | Social Worker | 100 River Place Drive, Ste 250, Detroit, MI 48207 | 2018-05-23 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1043723737 | Olivia Carter | Case Management | 2712 Gratiot, Detroit, MI 48207 | 2017-11-16 |
| 1558885590 | Kalimah Johnson | Social Worker | 701 Mcdougall, Detroit, MI 48207 | 2017-08-01 |
| 1922534692 | Angela Young | Social Worker | 100 River Place 520, Detroit, MI 48207 | 2017-05-02 |
| Find all providers in zip 48207 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093329849 | Hey Doc, P.C. | Internal Medicine | 1431 Washington Blvd Apt 2510, Detroit, MI 48226-1729 | 2020-08-31 |
| 1134744998 | Harish Harry Gidda | Internal Medicine | 22201 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-06-08 |
| 1770107443 | Arshan Ali Khan | Internal Medicine | 22101 Moross Rd, Suite 50, Detroit, MI 48236 | 2020-05-29 |
| 1871053751 | Jacob Diskin | Internal Medicine | 4201 St. Antione, Uhc 9c, Detroit, MI 48201 | 2019-03-25 |
| 1770092272 | Daniel Saul Mizrahi | Internal Medicine | 7633 E Jefferson Ave Ste 250, Detroit, MI 48214-3731 | 2017-09-27 |
| 1700304912 | Premier Care Rehabilitation | Internal Medicine | 10641 W Mcnichols Rd, Detroit, MI 48221-2303 | 2017-09-07 |
| 1427400431 | Aryan Shiari | Internal Medicine | 3990 John R St Rm Room3925, Detroit, MI 48201-2018 | 2016-07-01 |
| 1700236478 | Osh-mi Physicians Group PC | Internal Medicine | 18600 Fenkell St, Detroit, MI 48223-2315 | 2016-06-14 |
| 1184070815 | Khalil Ibrahim Bourji | Internal Medicine | 4201 Saint Antoine St Ste 4h, Detroit, MI 48201 | 2016-05-12 |
| 1124403779 | Swetha Edla | Internal Medicine | 22101 Moross Road Pb Suite 50, Detroit, MI 48236 | 2015-07-24 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.