Healthcare Provider Details

I. General information

NPI: 1972829356
Provider Name (Legal Business Name): MICHAEL A. MALANDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2010
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DALE ST STE 201
ANCHORAGE AK
99508-5445
US

IV. Provider business mailing address

PO BOX 4105
PORTLAND OR
97208-4105
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-2240
  • Fax: 907-212-2872
Mailing address:
  • Phone: 866-907-1068
  • Fax: 425-917-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number164773
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: