Healthcare Provider Details

I. General information

NPI: 1922788892
Provider Name (Legal Business Name): DIMA MALKAWI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE RM 6111
AURORA CO
80045-2527
US

IV. Provider business mailing address

9501 E 23RD AVE UNIT 318
AURORA CO
80010-1081
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2750
  • Fax:
Mailing address:
  • Phone: 202-538-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL0010006
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: