Healthcare Provider Details

I. General information

NPI: 1841299690
Provider Name (Legal Business Name): MONIKA A. MALECHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIKA BEDNARZ

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15950 SW MILLIKAN WAY
BEAVERTON OR
97003-5170
US

IV. Provider business mailing address

800 SW 13TH AVE
PORTLAND OR
97205-1902
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-0161
  • Fax:
Mailing address:
  • Phone: 503-221-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number04-30575
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2004004163
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD27068
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: