MEDICARE: JOHN MALINOWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1043154669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN MALINOWSKI

Provider Business Mailing Address
First Line	:	5609 BUTTRICK AVE SE
Second Line	:
City	:	ALTO
State	:	MI
Zip	:	49302-9276
Country	:	US
Telephone Number	:	616-307-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4370 CHICAGO DR SW STE 735
Second Line	:
City	:	GRANDVILLE
State	:	MI
Zip	:	49418-1694
Country	:	US
Telephone Number	:	616-341-7470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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