Healthcare Provider Details

I. General information

NPI: 1073597472
Provider Name (Legal Business Name): MICHAEL M MALMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 MCCARTNEY RD
YOUNGSTOWN OH
44505-5000
US

IV. Provider business mailing address

821 MCCARTNEY RD
YOUNGSTOWN OH
44505-5000
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-4440
  • Fax: 330-743-4488
Mailing address:
  • Phone: 330-743-4440
  • Fax: 330-743-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34005052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: