MEDICARE: MAXIMILIAN VON MALOTKY 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	363AS0400X	Surgical Physician Assistant
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A148839	CA

General Provider Information

NPI Number	:	1841582202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXIMILIAN VON MALOTKY M.D.

Provider Business Mailing Address
First Line	:	1800 BUENAVENTURA BLVD STE 200
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-3700
Country	:	US
Telephone Number	:	530-638-8868
Fax Number	:	530-638-8870

Provider Business Practice Location Address
First Line	:	1800 BUENAVENTURA BLVD STE 200
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96001-3700
Country	:	US
Telephone Number	:	530-638-8868
Fax Number	:	530-638-8870

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	06/24/2020

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