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General NPI Number Information
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NPI Number | 1437296290
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Entity Type | Organization
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Legal Business Name | MADONNA C MALLARI MD PLLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 9953 N 95TH ST SUITE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4593
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Country | US
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Telephone | 480-945-8360
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Fax | 480-945-4555
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Provider Business Mailing Address
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Address Line | 9953 N 95TH ST SUITE 105
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4593
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Country | US
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Telephone | 480-945-8360
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Fax | 480-945-4555
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Authorized Official
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Title or Position | OWNER PROPRIETER
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Name | MADONNA C MALLARI
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Credential | MD
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Telephone | 480-945-8360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 33207
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License Number State | AZ
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