Healthcare Provider Details

I. General information

NPI: 1851232193
Provider Name (Legal Business Name): KEVIN DAVID MALERICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PHYSICIANS DR
GREER SC
29650-2446
US

IV. Provider business mailing address

109 PHYSICIANS DR
GREER SC
29650-2446
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-9150
  • Fax:
Mailing address:
  • Phone: 864-797-9150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL96991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: