Healthcare Provider Details

I. General information

NPI: 1720027261
Provider Name (Legal Business Name): MICHAEL J MALIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 SCOTCH PINE CIR
WAMEGO KS
66547-9342
US

IV. Provider business mailing address

4665 SCOTCH PINE CIR
WAMEGO KS
66547-9342
US

V. Phone/Fax

Practice location:
  • Phone: 785-456-6941
  • Fax:
Mailing address:
  • Phone: 785-456-6941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-28347
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: