MEDICARE: MR. GENADI MALTINSKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	38713-020	WI
2	207Q00000X	Family Medicine Physician	18514	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1326349135	OTHER	WI	CMH SB NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	18514	OTHER	NV	STATE LICENSE
4	1851477913	OTHER	WI	CMH NPI
5	1134250905	OTHER	WI	CMH PCC G NPI

General Provider Information

NPI Number	:	1710966288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GENADI MALTINSKI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 98978
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-8978
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	3131 LA CANADA ST STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-2579
Country	:	US
Telephone Number	:	702-369-5582
Fax Number	:	702-650-5148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	04/08/2020

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Directions to “ MR. GENADI MALTINSKI M.D.” Practice Location

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