Healthcare Provider Details

I. General information

NPI: 1730101106
Provider Name (Legal Business Name): MARK D MALINOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 2
GARFIELD HTS OH
44125-1979
US

IV. Provider business mailing address

24701 EUCLID AVE
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-475-8844
  • Fax: 216-475-3816
Mailing address:
  • Phone: 216-475-8844
  • Fax: 216-475-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-073510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: