Healthcare Provider Details

I. General information

NPI: 1992960124
Provider Name (Legal Business Name): EUGENIA C MALENKOS D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 WEST 10TH STREET
INDIANAPOLIS IN
46202-1616
US

IV. Provider business mailing address

1410 W. 10TH ST.
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-4477
  • Fax:
Mailing address:
  • Phone: 317-998-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number41000219A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number07001111A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: