Healthcare Provider Details

I. General information

NPI: 1881794691
Provider Name (Legal Business Name): KEVIN JAMES MALONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE DEPT OF
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE DEPT OF
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-9080
  • Fax:
Mailing address:
  • Phone: 216-844-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number090235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: