Healthcare Provider Details

I. General information

NPI: 1861461097
Provider Name (Legal Business Name): MICHAEL S MALLONEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 W ARBORS DR SUITE 201
CHARLOTTE NC
28262-2663
US

IV. Provider business mailing address

6035 FAIRVIEW RD
CHARLOTTE NC
28210-3256
US

V. Phone/Fax

Practice location:
  • Phone: 704-295-3000
  • Fax: 704-295-3468
Mailing address:
  • Phone: 704-295-3000
  • Fax: 704-295-3468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number24453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: