Healthcare Provider Details

I. General information

NPI: 1982671194
Provider Name (Legal Business Name): DAVID I MALITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WALNUT ST
EVANSVILLE IN
47713-1963
US

IV. Provider business mailing address

1001 WALNUT ST
EVANSVILLE IN
47713-1963
US

V. Phone/Fax

Practice location:
  • Phone: 812-421-2020
  • Fax: 812-422-1189
Mailing address:
  • Phone: 812-421-2020
  • Fax: 812-422-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number10979
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01041297
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number30753
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: