Healthcare Provider Details

I. General information

NPI: 1023343100
Provider Name (Legal Business Name): MICHELLE KAY MALCHOW O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE 3RD AVENUE NE
CROSBY MN
56441-1667
US

IV. Provider business mailing address

ONE 3RD AVENUE NE
CROSBY MN
56441-1667
US

V. Phone/Fax

Practice location:
  • Phone: 218-546-5108
  • Fax: 218-546-5736
Mailing address:
  • Phone: 218-546-5108
  • Fax: 218-546-5736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3447
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: